Wednesday, November 04, 2015

Piling on: A physician's perspective

Right about the time that Kelley posted on the very real challenges that she's seeing at her practice (as well as her colleagues'), I received this in email from a physician:

"I've had issues with the way insurance is moving with caring for patients.  Many patients on high deductible plans want me to go over ALL their medical problems/concerns during their preventative visit then code it as preventative since that has to be covered 100%.  That just seems like fraud to me, and when I tell them I can go over their back pain and their side effects from their blood pressure medications but it's not preventative so there may be some charges, multiple patients have gotten very angry at me."

I of course pointed out that it is, in fact, fraud, and that it was wise to have declined the request. The rest seems to confirm what we learned from Kelley, and is likely to get worse.

I actually received a follow-up email this morning (in direct response to Kelley's post):

"I was seeing a patient for blood pressure and adjusting their medication because her blood pressure was still high.  She hadn't paid her bills yet, but I was still happy to see her for a follow up (we can set up a payment plan if a patient has difficulty paying their bills).  She asked my secretary if there would be an additional charge for that visit that day.  When my secretary said that, yes, a charge for that day's visit would be sent to the insurance company, the patient had a break down.  She started screaming that it's a follow up and should be covered under the same charge as her first visit.  She then said that if she dies it's our fault, refused to be seen if the visit wasn't guaranteed to be free, and stormed out of the office."

That'll teach that awful doc.


It seems to me that there are actually a number of different issues at play here:

First, it'd be interesting to know how many of these folks are newly-insured, and thus unfamiliar with how office visit co-pays have worked for a very long time. After all, the idea that co-pays apply to each discrete visit isn't new. And even on plans without co-pays (such as HSAs) it's always been the case that each visit generates its own charge.

I'd also be interested to see if this trend holds, and whether it drives more physicians to DPC or Concierge models.

Oh brave new world, indeed.
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