A doctor friend recently shared her frustration with Yelp!, one of the many doctor-ratings websites in existence, where patients can anonymously post whatever they want about a doctor. The disgruntled patient railed against the doctor and called her competence into question because his insurance didn't cover certain things (quel surprise!) and the patient gave her a one-star rating out of five.
Here's the thing: you aren't a success until you have people who love you as well as the people who don't. With this in mind, this is how people conduct themselves with respect to insurance fraud.
KA-CHING. The attitude is, "hey! it's not my money, let the insurance figure it out. I've already paid enough and I'm not paying any more". Think of all the people who have boasted of a generous payout on their auto accident claim, or flood claim, etc. In America today, insurance fraud is a way of life, and one of the biggest reasons why the cost borne by the consumer keeps increasing.
Third party medicine makes the exam room too crowded--doctor, patient and insurance company. You not only have to be a superb physician and have a warm bedside manner delivered with a painted-on smile, you also have to know every copay, code, modifier and deductible in advance. And these change weekly, sometimes entirely cancelled and replaced by new bureaucratic codes. The situation is not sustainable and is doomed to fail. It will only get worse with increasing regulation and bureaucratic red tape--hello, HIPAA 5010 updates? PPACA?
Many physicians have gone cash-only, opting out of insurance/Medicare/Medicaid completely and I can only see the trend increasing. BCBS and UHC have online real-time plan look-ups where you can see at registration what the patients' copayment or responsibility will be, and if they have a $5000 deductible, we tell them so, and collect payment on the day of the visit. You forgot your wallet? Reschedule. Everything else? Cash/Visa/MC/Discover accepted. "Here is your superbill so you can send it to your own plan. "
I will also say that sometimes it makes more sense to limit the scope and volume of a practice. You can't be everything to everybody. I briefly contemplated interviewing patients before deciding to accept them into my practice. Pragmatically, it didn't work. But I am mindful of the patient interaction from the beginning, from the phone conversation in booking an appointment to their behavior in filling out a new patient registration sheet. My staff tells me everything, as bad behavior with front-desk staff predicts inappropriate behavior, nearly always. I've had patients refuse to sign the financial responsibility sheet and then I've refused to see them. The doctor-patient relationship is a two-way street, we are not technicians repairing a flat tire. This is a personal service involving vulnerability, for both the patient as well as the physician.
Doctor review websites are a reality. Physicians have zero legal recourse in addressing those defamatory statements, I think HIPAA even makes it illegal to respond. Some physicians have patients sign contracts that are basically gag-clauses, where the patient must consent to NOT post on these websites. Frankly, I think our core mission is being diluted in all of this crap. Let's just be doctors. Reject third party medicine. Attacking the doctor because insurance didn't pay will only reduce access to doctors in the future.
