Only The Doctor Is At Fault


Felix Gautier was cross.  “But you lied, Lapius,” he chastised.  “You shouldn’t have.  You can get into trouble you know.”


“Not really a lie, Felix,” S.Q. Lapius demurred, “merely an omission.  I simply would not state on   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 once the patients made contracts with Blue Shield and/or Medicaid,  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   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 recovers, 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.”