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Friday, February 25, 2005

Professional Courtesy,Once the Rule- now illegal

Even as a medical student I enjoyed what was known as professional courtesy.I developed the med student disease of having every disease we read about and became alarmed about a nevus on my back. I saw a general surgeon who removed it in the office and scribbled "N.C."on my routing papers. Wow ! I was in the fraternity already. For many years it was estabished practice for physicians to not charge physicians and their families.40 years later,no such NC appeared on my papers as I checked out of a orthopedic group's office.Twenty dollars is no big deal;the big deal is once again the insurance industry wins out over physicians. Basically-in at least some states- the insurance lobby has passed legislation making it in some instances insurance fraud for a doctor to not charge a patient the co-payment. The Attorney General in Texas has issued a ruling clarifying the Insurance Code indicating doctors cannot waive the copay at least in the situation where it could be construed as an effort to entice patients. The Texas Medical Association in its practice managment publication states that according to Texas law it is fradulent to submit an insurance claim that does not disclose the intent to waive a copay for a patient.The insurance companies want to make patients pay a copay to discourage utilization. They wish to not allow doctors to offer waving copays to attract patients.They also present the following bogus argument. If a doctor nominally charges $100 and the insurance pays 80% the plan is for the patient to pay $20.If the doctor waives the twenty he in effect is only "charging" 80 so insurance "should" only pay 64.The insurance company will allow waiving of copayment in cases of financial hardship but typically insists the doctor notify them of the situation.Now the physician may be able to simply forgo all payments and not even file, but the old practice of charging insurance only is becoming a thing of the past.

1 comment:

Epador said...

Problems with PC:

1) These days, most docs make more money than most of their patients -- so why PC?
2) Taking care of a doctor ought to be a carefully thought out process: there are actually many more risks for error than a "routine patient" and adding PC into the process further muddies the waters. The person receiving free care may be more reluctant to "bother" the caregiver with questions, problems or complications. The provider may (sadly) be tempted to think along the same lines as the patient, and wonder why the physician patient is so demanding about something they didn't even pay for.

Nice thing about PC:
One of the few things left you could do to foster collegiality in an ever increasing cut throat business of medicine atmosphere.