Any doctors or lawyers in the house?

[Terpsichore]

The sad thing is, I had to field a phone call yesterday from a patient asking why he was getting billed for those tests.  He felt doc misled him, yet I remember watching the office manager tell the patient specifically that if doctor runs any tests, we would send them to his health insurance.  Doc ran tests, we sent them in, his insurance said "ok, this was a justified charge according to the ICD10 codes found.  Patient has not met his deductible, so he will owe it."  I begged doc that he needs to be crystal clear from now on before he DOES get sued.  He claimed that if he gives patients the option to not have the tests, and something goes wrong down the road, he will be blamed.  Is this true?  "Mr. Jones, here is what I am seeing, I would like to run this test to make sure it isn't something serious because (insert reason here).  This isn't part of the basic exam and will be billed to your health insurance as this is for the health of your eyes.  Would you like to proceed with this option?"  If he properly documents the consent or the pass, then he (in theory) should be ok, yes?  Patient can't complain about the charge because they agreed to it and they can't blame doc for any issues later because they didn't have the test run.  I just want to do right by our patients and help them get the best care possible.

[Hawkmoon]

There is a legal concept that seems to be sadly lacking in the medical professions these days, called "informed consent." It means having the doctor or someone clearly explain things to the patient, and get the patient to sign off on anything that might be an additional charge, or to sign off on declining any tests that the doctor might advise that are not part of a basic appointment. Your doctor is not alone in failing to grasp the concept that patients don't like to be subjected to a bait-and-switch.

You wrote that you heard the office manager "tell the patient specifically that if doctor runs any tests, we would send them to his health insurance." I hope you understand that many people don't fully understand their health insurance -- and it's worse now, especially for seniors. I get my Medicare supplement through an agent. She's the sister of a high school classmate and I trust her completely. I haven't had the same carrier for two years in succession since I signed up for Medicare, because the companies change the plans every year. Your patient may not have understood about deductibles, or may not have know how close he was (or wasn't) to meeting the deductible.

My guess is that your office manager said "we'll send the tests to [your] health insurance," and the patient heard "Your health insurance will pay for the tests." IMHO, your office needs a printed form that spells out that you will submit bills to the patient's health insurance provider but that your office does NOT determine whether or not the insurance provider will pay, and that the patient is responsible for any amounts not paid by the insurance. The patients need to sign an acknowledgement that they have read this and understood it.

I think there should also be a form on which the doctor discloses any recommended tests that aren't included in the basic exam, and the patient checks a box to either accept or reject each recommended extra service. Yes, I get that the doctor is worried that he might be sued. If I were him, I'd be more worried about being turned in to the medical board for racketeering. If my doctor pulled that stunt with me once, it would be the last time he (or she) was my doctor.

[Terpsichore]

THIS!  So much THIS!  You just hit everything on the head!  Yes, I understand a majority of our patients don't understand their policies and a lot of that bunch have selective hearing.  We've been tossing around the idea of a form for informed consent for a few weeks now.  After this last call, I'm thinking we shouldn't give doc the choice.  We get the forms, clip it to the route slip so doc sees it as a reminder, change our verbiage at time of check in, and go from there.  Patient has everything clearly laid out, doc has his rear covered...everyone is (again, in theory) happy.

[Hawkmoon]

There's really more to informed consent than just insurance, of course. Millcreek can probably expound on it far better than I. The insurance and billing aspects are just a sideshow. The meat and potatoes of informed consent is that the patient should know what the doctor is doing, understand the [medical, as well as financial] benefits and disadvantages, and be given enough information to be able to make an "informed" decision whether or not he wants to proceed.

Regarding extra-cost tests, what that wuld mean is not just telling the patient that "This test I'm recommending might not be covered by your insurance," but also explaining what the test is for, why the doctor thinks it's necessary, and what the downside could be if the patient declines the test and thereby doesn't have a problem diagnosed that the test would have picked up.

Being the skeptic that I am, I think that your doctor's concern about being sued is either only part of the issue, or else a complete smokescreen. I think he really just doesn't want to spend the time with each patient to explain things in sufficient detail for the patient to understand --- and thereby to give "informed consent." I'm going to guess that your doctor probably schedules appointments pretty close together, and he probably pushes patients through pretty much on an assembly line basis. If I'm right, that's not fair to the patients, and its a poor way to run a medical practice.

[Brad Johnson]

Remind the doc that most state licensing boards take ethics violations very seriously. Patient consent complaint fall squarely in that category. Get enough of them and the licensing board will initiate a formal inquiry.

Brad

[Terpsichore]

I'm going to guess that your doctor probably schedules appointments pretty close together, and he probably pushes patients through pretty much on an assembly line basis. If I'm right, that's not fair to the patients, and its a poor way to run a medical practice.

Nope.  Hour long appointments in the schedule, but we'll have patients there for an hour and half...two hours...three....