Only The Doctor Is At Fault
Daily Observer
Felix
Gautier was cross. “But you lied, Lapius,” he chastised.
“You shouldn’t have. You can get
into trouble you know.”
“Not
really a le, Felix,” S.Q. Lapius demurred, “merely an
omission. I simply would not state on
either the Blue Shield or Medicaid forms that the patient had been in an
automobile accident.”
“That’s
a lie,” Gautier persisted.
“I
repeat, Felix, an omission.” Lapius reiterated.
The argument was getting nowhere.
I knew quite well what Lapius was doing but
Gautier was mystified.
“If
the patient had been injured in an automobile accident why not say so, Simon?”
“Because
I choose not to,” Lapius said firmly, trying to turn
off the conversation as if it were a spigot.
I
tried to enlighten Gautier, who was trying an accident case that was being
distorted by Lapius’s recalcitrance.
“He
objects to having to deal with the insurer on Medicaid cases. As a matter of fact, Felix, Lapius feels that the patients took out contracts with Blue
Shield, and the state assumed responsibility for medical costs to the patients
in welfare. Lapius
resents the fact that as soon as an auto accident is the cause of injury, that
both of these insurers deny payment and asks the physician to deal directly
with the insurance company.”
“Why?”
Gautier asked innocently, as if Lapius had left the
room. “What difference does it make from
whom the doctor collects the bill?”
“Well,”
I tried to explain, “Lapius takes the position that
Blue Shield and Medicaid should try to collect from the insurance company after
paying the doctor his due bill. He feels
that these organizations have no right to suddenly shift responsibility to the
doctor for collection. As a matter of
fact, in cases of collision, the doctor must treat the patient until he or she
has recovered, and then try to collect from the insurance company. If the insurance company believes the bill to
be too high, then the doctor has to go to Medicaid or Blue Shield for the
difference, and indeed, they may not pay it.
But more than that, it is the arbitrariness of Blue Shield and Medicaid
that he objects to.”
Lapius interrupted.
“That’s enough, Harry. I am
certainly capable of handling my own arguments, particularly with a lawyer who
deals in these matters.”
He
turned to Gautier. “It would seem clear
that Blue Shield and Medicaid, and you can throw in Medicare, have suddenly
decided to duck a responsibility that they have voluntarily assumed – that is
to pay all or a designated part of a patient’s medical bill. IF there is a possibility of their retrieving
some of it from an insurance company, more power to them. But they have no right to arbitrarily shirk
the responsibility that is theirs to begin with. It is high handed, and I can’t find anywhere
in the small print that they have the right to do this. I am busy enough in my office without having
suddenly to search out insurance companies and dicker with them about billing.”
“But,”
Gautier interrupted, “It is automatic. With no fault.”
“Yes,
with no fault the patients suddenly know that if they can run the bill up to
over $200 or some such figure, other goodies can befall them. Felix, have you ever seen a patient on the
make with an insurance company react when you suddenly tell them that they are
cured? My word. If they are carrying a cane they will surely
strike you with it. If the news is
sprung too suddenly, particularly with the distaff patients, they might faint
dead away on the floor of the examining room.
Upon my word, Felix, the most dangerous thing a doctor can do is tell a
patient who is expecting an insurance bonanza that he is suddenly cured. That’s why I won’t mention ‘auto’ on the Blue
Shield or Medicaid forms. I once had a
youngster who caught his finger in the automobile door, and the third parties
refused to pay for the medical bill because it was an ‘auto’ door. Had I just mentioned the word ‘door’ by
itself I would have avoided all complications.”
“You
will get into trouble, Simon,” Gautier insisted. “If you do not mention that the accident was
due to an automobile you are denying the patient the right to collect his just
deserts.”
“Not at all, Gautier.
I explain to the patient that if they want to make an insurance case out
of it, they can pay me cash for each visit and I will gladly support their
claims to the auto insurers. You would
be surprised what a healthy incentive this policy is to patients who otherwise
might not be in a hurry to get well. If
they consent, we sight the appropriate releases, and proceed with therapy. If the patient refuses, then I refer him to
another physician who doesn’t mind billing the insurance companies directly. It is a matter of simple fact that I will not
get involved in this game.”
“But
don’t you think that the patient has a right to collect for injuries suffered
in an accident?”
“I
don’t think about it too much. I am concerned
only with the patient’s health,” Lapius said smugly.
“But
if I were to think about it, I surely would hope the patient would collect for
his disability. However, I don’t see why
the burden of this should be placed on the shoulders of the physician. Either the patient or his medical insurers
should be responsible for the bill and they should collect from the insurance
companies. That they shirk this
responsibility makes me suspicious. I
also resent the fact that the matter has been handled unilaterally, that the
physician hasn’t been consulted.”
“Simon,”
Gautier said, trying to be conciliatory, “I happen to represent a patient of
yours injured in an auto accident. You
will have to come to court to testify.
It may be embarrassing to you, the fact that you failed to mention auto
accident on the forms, and were able to collect your fees from the third
parties.”
“And
if I don’t testify?”
“You
will be in trouble with the third parties.”
“A sticky wicket.”
“Well,”
said Gautier, “that’s no fault insurance,”
“Sure,”
said Lapius, “No fault of anybody except the doctor,
I guess.”