A recent addition to the standard financial responsibility verbiage in the standard physician form
A recent addition to the standard financial responsibility verbiage in the standard physician forms is the agreement to pay or accept responsibility to pay for services if the insurance company does not cover the visit or portions thereof. Wait! What? Isn't that why I have insurance? Isn't that what my premiums are for and what my co-pay covers? This is all too common today, and the policies (our policies) are too confusing to read and know exactly what our responsibility is. Coincidence? Discuss your feelings about the physician's office or hospital's level of commitment to verifying benefits and assuming responsibility for their errors.
Consider your feelings on making policies "plain language" so they can be understood and quickly clarified. Should you, as the patient, be responsible if your insurance company does not pay for a service that your physician orders? Should you be responsible for fighting to get that service paid for? Back up your opinions with references and in-text citations to course readings, lectures, or external articles.
Sample Solution
You're right to be concerned! This shift in financial responsibility language is a growing trend that can leave patients confused and unfairly burdened. Here's a breakdown of the situation and some arguments for clearer communication:
-
The Current Landscape: Studies by the American Medical Association (AMA) show a rise in "surprise billing," where patients are on the hook for services they believed were covered by insurance [1]. This often stems from out-of-network providers or services deemed non-covered. The added language in physician forms pushes more financial risk onto the patient.
Full Answer Section
- Why Plain Language Matters: Dense legalese in medical forms can be overwhelming and difficult to understand for many patients [2]. Research by the Center for Plain Language Law highlights the importance of clear communication in healthcare documents. Patients with a better understanding of their financial obligations are more likely to ask questions and advocate for themselves [2].
- Shifting Responsibility: There's an argument to be made that physician offices and hospitals have a responsibility to verify benefits to a reasonable extent. The American Hospital Association (AHA) emphasizes the importance of patient communication and cost estimates [3]. However, the onus shouldn't entirely fall on them.
- Request an Explanation:Don't hesitate to ask your doctor's office to explain the new language in their forms.
- Seek Preauthorization:Discuss getting pre-authorization from your insurance company for any non-routine procedures to avoid surprise bills.
- Advocate for Yourself:If you disagree with a billing decision, contact your insurance company and appeal it. The National Patient Advocate Foundation offers resources to help patients navigate the healthcare billing maze [4].
- You shouldn't be solely responsible for fighting for coverage for services your doctor deemed necessary.
- Ideally, there should be a shared responsibility between you, your doctor's office, and the insurance company.