When the Question of Insurance Arises
Question: When visiting a doctor for the first time, one is usually asked, “What is the name of your insurance company?” Do I have the option of answering: “None of your business?” Or maybe answering that question with one of my own: “And what is the name of the doctor’s malpractice insurance company?”
It is my understanding that doctors have two levels of fees: one for those who have insurance, and one for those who don’t. The haves, I have learned, are charged a higher fee. If I intend to pay my bill in full at the end of my visit, what obligation do I have to inform them whether I am a have or a have-not? I would like to do what I can to keep down the skyrocketing costs of health insurance, and that includes my group health insurance.--B.A.
Other people (occasionally) answer this question . . . as if (insurance) is a status symbol. Don’t they realize that it exposes those “deep pockets” of the insurance companies and that some doctors will charge whatever the market will bear? I don’t believe that all doctors would (gauge) the insurance companies. My problem is that I don’t know who the honest ones are and who the dishonest ones are.
Do I have the right to refuse to answer that question and still be treated like any other patient? And, more importantly, will it do any good?
Answer: Your question illustrates a point that C. Everett Koop, the former U.S. surgeon-general, has touched on: the deterioration of the doctor-patient relationship in recent years as patients have come to distrust their doctors and the doctors have started feeling threatened by their patients. The subtle shift began, Koop believes, when doctors started being viewed as “providers” and patients as consumers.
According to Susan Sherry, a spokeswoman for the National Health Care Campaign, a research group in the field of health insurance needs, “fee practices in the medical profession are so varied that it’s impossible to generalize.” Some doctors probably do some gouging, she said, “but we doubt very much if it’s commonplace. . . . Many (doctors), if not most of them, do indeed have lower fees for those patients who are uninsured and, in many cases, treat them without a fee at all. Their standard response (to the two-fee structure) is: ‘This is how we fulfill our social responsibility.’ ”
Coming from a lobbying organization concerned with the need for better, more affordable health care, this is an interestingly pro-doctor response. We can view it as a higher fee for the insured, or we can view it as a lower fee for the uninsured.
“I really wish the situation were as simple as the person’s letter makes it sound,” said Bob Calverley, a spokesman for the 10,000-member Los Angeles County Medical Assn. “Most physicians routinely treat people with no insurance--as well as old patients who have lost their jobs or experienced other financial problems--at a lower rate. And I know quite a few of them who don’t even bill the state for some of their MediCal patients because the paper work makes it more trouble than it is worth.”
Calverley concedes that the insurance question on a patient’s initial visit is a fairly standard operating procedure. But not, he says, for the reason you suspect--so that patients with insurance can be billed at a higher rate.
“The whole insurance picture has gotten so complex that it’s to the advantage of both the patient and the doctor to discuss fees and how they will be handled right up front,” he says. “You’ve got about 1,500 insurance companies selling medical coverage and you’ve got three major approaches to that coverage--a plan where you choose your own doctor, a plan where you go to participating doctors, and then you have your HMOs (Health Maintenance Organizations)--and they’ve all got different fee structures. And Medicare has its own rules altogether.
“How different insurance plans interpret ‘elective surgery’ is a good example. You’ve got all sorts of variations, and as a patient, you don’t want to be lying in the hospital and suddenly find out that, under your policy, your plan doesn’t cover nearly as much of your costs as you thought it would.”
NHCC’s Sherry suspects that some doctors may indeed want the insurance information so that they can slap a higher fee on patients who have the insurance.
But like Calverley, she believes that the reason usually is far less sinister: The doctor is just as likely to charge a lower fee for those without coverage and he wants to be able to discuss fees and treatment openly with the patient.
“There are going to be communication problems occasionally,” Calverley says, “and there is certainly a lot more negotiation about fees between patients and doctors than there ever was in the past.
But . . . if the patient feels as uncomfortable as he obviously does with this doctor, then he’s probably got the wrong doctor.”
Do you have to tell the doctor whether, and with whom, you have medical insurance? Of course not. For that matter, you don’t have to tell him where you hurt either.
