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.”