This is a spin off of Kathleen's post about Podiatry salaries out of residency.  What do you do with the patient that would benefit from an 'elective' office procedure that is not a benefit of their insurance.  For example, a patient would benefit from bilateral heel trigger point injections for plantar fasciitis.  But the insurance benefit is only one procedure per visit.  What would you do?

I would expalin to the patient and let him decide if he wants both now ,but he must pay out of pocket for one.  The fully informed patient  has free will.

If the insurance will pay for one procedure/injection per visit I would suggest doing one side one day and having the patient return at a later date.  I think this speaks to the larger problem of when insurances don't cover what we think is a necessary procedure.  In my location (Central Oregon) our local Medicaid provider will not cover bunion surgery.  I have had patients who need the procedure but will not receive coverage.  Apparently the local carrier is defending itself in lawsuits because of denied coverage.  A very unfortunate situation.

Frankly, I am much lazier than most doctors. If I find that the patient is not covered for a particular service, I often treat them anyway, document it, but may not bill for the service (which I know I won't get paid anyways).

I do a casual "means" test. I can make an educated guess from their face sheet & demographics (what their occupation is/was, which neighborhood they live in), then I can tell fairly accurately what they have (asset-wise). 

First of all, I think one of the most important jobs we have is the education of our patients.  If this scenario exists in my practice (which sometimes It has) the only options we have are the following:

a)  Inform the patient of their benefit package.  They need to know what is covered and what isn't.  They also need to know how much of what you do is covered.

b)  Inform the patient of the underlying pathologies that would NORMALLY be covered if they had ABC insurance vs. their current.

c)  You have to provide the patient with a choice, to treat or not to treat?

d)  if they want it treated but cannot pay, pull out the ABN form, or dn't treat it.

Eric

Can you say "PUBLIC OPTION?"

Kathy--

Maybe.  The thing that i wonder about is when there are attempts to provide low-cost coverages (as the public option would have to be to not significantly increase the debt) is that will these plans include payment for routine-care type items that we would/could provide in the office, or will it be more like a baseline "emergency insurance"?  I remember when i was in college, i HAD health insurance that i purchased through the school, but it covered very little and required significant co-pays.

So the question remains, will a government funded option which nominally provides health insurance pay for the services that we might offer (and are not being covered) as described in this topic thread?  Who knows.  The reality is, however, that you NEVER get more services for less money.

I doubt a public option will cover any "elective procedures" as described by the OP.  Luckily, I usually don't deal with elective procedures, but in cases where the insurance will not cover a proposed treatment --- I explain that to the patient, determine if there is an alternative, and if not, they must pay cash.

If you need an accountant, you must pay cash.  If you need a lawyer, you must pay cash.  If you go to a dentist and don't have dental coverage, you have to pay cash.  If you don't have homeowners insurance and you get robbed, it was your risk and you unfortunately must pay cash.  No difference in medicine. 

Dear Friends,
I am afraid that you all are probably correct and that means that I am probably doomed.

Without institutionally provided healthcare, and a history of cancer, I am uninsurable. Therefore I am waiting for the Republican healthcare plan. And waiting....

Having seen none on the horizon for months, I am left believing there is only Rep.Grayson's idea of: "Die Quickly"

I hate to think that is my only option (I really enjoy life and think that I have something to offer to the world) and believe that uninsured patients do as well.

I wish there were more physicians in Congress contributing to the dialogue in a more helpful manner.