Also, disingenuous doctors
Tuesday, October 16 2012
Birdstrike, MD has a post– titled “To the patients who resent greedy doctors” — on Kevin, MD about horrible, horrible patients and their insane resentment of greedy doctors. He is responding to a comment on a previous post at WhiteCoat, MD, about the Martello case, something I just learned about. I’ll let WhiteCoat summarize:
A plastic surgeon is being sued by California State because she charges patients fees in excess of what insurance pays for her services. California’s lawsuit alleges that the doctor poses a “substantial, irreparable, and unjustified threat to the financial livelihood” of her patients.
In addition, the California Medical Board is attempting to revoke her medical license because she is allegedly engaging in “unprofessional conduct” by requiring patients visiting emergency rooms to sign agreements to pay her costs if their insurance companies didn’t.
[...]
However, with one caveat, I think that the actions taken by the state and the medical board are way out of line.
Suing a doctor and trying to revoke her license because she wants to get paid the asking price for her services? If people don’t want to pay her price, then don’t use her. Go see another “professional.”
And if you think the caveat is “She should not have gone after the patient’s house” — as in, put a lien on it and tried to have it sold to cover her costs, you would be wrong. But that’s what this physician did. And she has done similar things to other patients, as well.
You may think, ‘well — she did provide a service, she deserves to be paid’. And she did get paid — by the patients insurance companies. She just thinks she should be paid more than the insurance companies allow, and she thinks this money should come from the patients. But in California there is a law specifically prohibiting physicians from ‘balance billing’ — that is, chasing patients for what insurance doesn’t pay. Physicians and providers can sue the insurance company, if they feel so inclined, but are not allowed to sue the patient.
Of course, she had her patients sign a consent form agreeing to pay whatever she thought she deserved. Which is fine, if you think state law can be overruled by a contract between two private parties. But it can’t. You can’t shoot me just because I signed a consent form. Just because a prostitute has you sign a contract doesn’t mean prostitution is legal.
Whitecoat and Birdstrike have their stethoscopes in knots because they think patients resent physicians just for wanting to get paid. But what the physician in this case did is illegal. It is against the law in California for her to chase patients for money she thinks she is owed. She broke the law. It’s not that she’s greedy: it’s that she’s a greedy criminal.
You might say that the laws are unfair to hard-working medical providers. Perhaps. But Dr. Martello chose to do business in California, applied for and received a license from the California Medical Board, and likely expects the laws of California to protect her from any number of harms — even as she abused the courts to hound her patients. And she has a law degree, so she knew exactly what she was doing.
And WhiteCoat thinks she should retain her license. Who makes that decision? The California Medical Board, which has six physicians on it and four non-physicians. So even her peers think she is abusing her patients and breaking the law. They’re right: she deserves to lose her license. They started going after her license for a botched breast augmentation, but added the lawsuit business later.
Let me finish with some wonkery: in his post, Birdstrike reasons that if people value their lives tremendously, emergency room doctors should be paid tremendously. He thinks there’s some sort of economic theory to explain why that doesn’t happen, and there is: it’s called ‘supply’. Demand alone doesn’t determine the price of something, but where that demand sits in relation to supply. And one of the things organizations like the California Medical Board do is limit the supply of medical providers. Which can be a good thing: it keeps Birdstrike and Whitecoat from having to compete against unqualified, discount quacks. But it also informs the price they get for their services. The supply of medical services has absolutely nothing at all to do with patients. That is determined by medical schools and licensing boards. So Dr. Birdstrike not only is blaming patients for something that cannot possibly be our fault, but expects us to feel sorry for the “toxic and misguided negativity” physicians deal with. If he can’t take the heat, Birdstrike can always quit his practice. I can’t quit being sick.
Drs. Whitecoat and Birdstrike are being disingenuous. This is not about a physician not getting paid. This is about a physician who broke the law — repeatedly, egregiously — getting exactly what she deserves. We can indeed resent her, righteously and freely — and also her disingenuous defenders.
You just taught me something I didn’t know, and I live in CA. Just curious: does this also have any bearing on the growing trend of MDs who no longer accept insurance and/or who practice “concierge” medicine? These practitioners make you pay up front, but then give you superbills for your insurance. I’ve run across some who are still on insurance preferred provider lists, but completely ignore what the insurance company says should be reasonable and customary by making you pay up front.
Selena — I don’t know whether Dr. Martello’s case relates to ‘concierge’ medicine. From what I have heard/read about it from a couple of doctors who have that sort of practice, I do think there is often a sense of entitlement — that they are somehow better than the rest of us. But I think Dr. Martello was just a straight up greedy doc who wanted to bend the rules in her own favor.