A Physician’s New Reality: Patients Ask Me to Break the Law
Obama won, Obamacare is the law, and, as my wife says, I will just have to learn to dance to a new song.
Now, don't get me wrong, Obamacare is awful. Forget all the "free stuff" it provides. Children covered on their parents' plan until 26 years of age? A scam, making young adults -- excuse me, children -- pay for complete, comprehensive health insurance when all they need and should pay for is major catastrophe insurance. Then there is the "annual " or "preventative" exam, which according to Obamacare is "free."
You gotta love this stuff. I wish I had the chutzpah of the people who wrote Obamacare. What they did not tell you, and I am, is that it covers absolutely nothing more than the bare minimum.
I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam -- no co-pay, no deductible, no charge. That's fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and "discussion about the status of previously diagnosed stable conditions." That's the exact wording under that code -- insurance will not cover any new ailment under that code.
If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code -- that's illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud.
You, the patient, will then have to make a decision.
Do you want your "free" yearly exam, or do you want to pay for a visit which is coded for a particular, new problem? You can have my "free" exam if you only discuss what Obamacare wants me to discuss.
This happened to me personally, as a patient, when I went for my physical. It is the law. If you are complaining of a new problem, then you have to reschedule, since Obamacare is very clear as to what is covered and what is not. Obamacare -- intentionally -- makes it as difficult to be seen and taken care of as possible.
Patients can be very tricky. I have had patients make an "annual" exam, only to want to discuss and be treated for another ailment. I can’t do it.
I can hear the complaints from you guys already -- I become the bad guy. “Why don’t you just take care of the problem, and not bill out any different code? You’re a rich doctor, and we are entitled to free stuff.”
It doesn't work that way. First, doctors are not rich and, like most of you, actually work terribly hard for a living. Second, Obamacare is the law -- and as I said earlier, we are audited all the time now.
Also -- I don’t ask for free gas when I go to the gas station, or ask for free food from the supermarket. Additionally, Obamacare has a 23% cut in Medicare reimbursement to doctors and hospitals.
These lower payments won’t cover the cost of staying in practice to take care of the patient.
Private doctors are becoming a thing of the past. By 2014, less than 25% of physicians will be in private medicine. Obama was right in stating you can keep your doctor if you want to -- the problem is he or she will rarely be available.
On top of all of that, doctors will be obligated -- that's right, obligated -- to talk to you about things you may have no interest or need to talk about.
You may just want to have a pap smear or check your cholesterol. However, I am now mandated by the government to talk to you about your weight, exercise, family life, smoking, sexual abuse(!), and even to ask if you wear seat belts. And I am mandated to record your answers.
I am a physician. But I need to tell you to wear a seat belt and then record your answer.
I have received interesting responses from my patients since I put up the notice. Almost all are supportive and totally understand. The very few who complain? The same patients who always ask for free samples, who always complain that we do not validate parking. These are also the same patients who call my office and ask for free samples even when they are not even being seen.
Obamacare and its 2,000-plus pages are here to stay. I will still give my patients 100% of my time, energy, and knowledge. I still love being a doctor -- my patients’ doctor. I will, however, abide by the law and follow it to the letter. I will have to learn this new dance. “Free” has its price.
Also read: You Break It, You Buy It