Man comes in for a physical. Thanks to the new healthcare law, there is no longer a co-pay for this preventive service. He is pleased.
We notice that he has an unpaid balance from an earlier visit a year ago. We have billed it to his insurance, which denied the claim, stating that the visit was for a pre-existing condition and was therefore not covered. We explain this to the patient. He is not pleased.
He states that the previous visit was not, in fact, for his pre-existing condition of asthma (for which the documentation clearly states the visit was scheduled), but rather to discuss his erectile dysfunction, which he states is a new problem. Because it is not a pre-existing condition, the insurance should pay it. He is pleased to explain this.
Never mind that we evaluated, discussed, and managed his asthma during the visit (clearly documented) as well as his ED (also documented). Never mind that neglecting to include the asthma diagnosis on the claim would constitute insurance fraud. Never mind that we’ve gone round and round with the insurance company for six months, and then billed him for the next six months. Never mind that he has been told that his insurance contract is between him and the insurance company, whereas we are merely the ones actually providing him with medical care.
We request payment owed for services rendered. He is not pleased.
His precise words:
“I don’t think I should have to pay.”
Really? For services already rendered? Does he think the water, electric, and phone companies would be perfectly happy to continue providing me with services if I decided randomly that I shouldn’t have to pay for them? My lawyer and accountant would have me in small claims court in a jiffy if I decided after the fact not to pay up. Why are doctors any different?
Why do people seem to think that the terms of their contract with their medical insurance company doesn’t really apply to them?
Talk about entitlement!