Groans from the staff.
“We have been told by corporate that we cannot ask if someone is in the three month grace period or if they are paying their premiums. We have to see them, though, even if they have not been paying their premiums. If they have not paid their premiums after the three months, the insurance company will drop them and demand that we refund the money they paid us.”
“Wait.” I leaned forward. “They don’t go after the patient? They go after us to get the money back?”
“So then we have to get our money back from the patient?”
“Like that is going to happen.” I sat back and crossed my arms across my chest and squinted at her. “Is this really true?”
After the meeting, I pulled her aside.
“How can the government do this and expect physicians to sign up for these plans? We are taking tremendous financial risks, then. Most of these people need to get caught up on immunizations, preventive care labs… hundreds of dollars worth of stuff. We can’t do it right out of the box, then. They will have to come back in three months. But then that makes us take a hit on our preventive care numbers.”
“I know.” My office manager was trying to keep her impassive face in place. “But this is what legal is telling us.”
Truthfully, I was hearing that other physicians were calling to verify insurance premium payments but were having great difficulty getting that done since it was requiring upwards of an hour on hold to get the info for each patient. No one has the staff for that kind of thing.
“Is this just one of those overly cautious, let’s not even remotely maybe get into trouble interpretations that legal is known for? Or is it for real?”
“That I don’t know.”
And we still don’t know. Not for sure.
I don’t have time to read 11,000 pages of legislation, nor do I have any idea who to ask. There are plenty of ways to help patients “navigate” the system. Not so much for physicians. So I have to follow the guidelines that have been handed down through legal and cross my fingers.
The fact is, my office, and thousands like mine, are not rolling in the overwhelming bounty of the medical cash cow. I have a 50% overhead. Our practice currently has over $150,000 that has not been paid to us over the past year, much of which will never be paid by the patients who owe it. We run a tight ship. Primary care is like that.
But the money issue isn’t the most upsetting part. It is the not knowing. Not knowing who or what to ask. Not knowing if I have been given the right information or if that information has changed. Waiting. Waiting to see if we are going to take a hit.