How Patients' High Deductible Insurance Plans Pose Malpractice Risks to Doctors
Patients are increasingly choosing high deductible insurance plans to reduce their monthly insurance premiums. Under these plans, it is understood that the patient must pay for their own medical expenses until costs reach a deductible that can be thousands of dollars. These high deductible insurance plans can pose a malpractice risk to physicians. The amount of patients with health insurance has increased due to the Affordable Care Act, nevertheless, the majority of these patients pick high deductible health plans. The number of patients with high deductible plans has increased to 17.4 million in January 2014, up over 12 percent from the previous year. The dilemma that physicians are seeing with these high deductible plans is that patients are making medical appointments less often and are also bypassing medication refills or declining medical tests. Patient choices to forgo aspects of their health care can have disconcerting consequences for physicians. A case reported in Massachusetts Medical Law Report shows these possible effects. A doctor was sued for malpractice by the family of a patient who died after a late stage cancer diagnosis. The patient, a 65-year old man, was a patient of the physician for four years; however a a complete physical examination was never performed, including colon rectal cancer screening, during that time. The cancer was not diagnosed until the patient went to the hospital with no bowel movement for several days and abdominal pain for several hours. Stage IIIB colon cancer was discovered. The physician said he did not offer the patient cancer screening because he was only seeing him for blood pressure tests, not for complete primary care. During his visits, the private-pay patient declined any additional medical care beyond those blood pressure tests. The case was settled for $1.5 million. The risk that doctors may be held accountable for patients who decline care is likely to increase as patients put off or skip screenings that are not insured by insurance. To protect themselves, doctors must clarify the risks of skipping tests and follow through on whether they have been performed or not. Physicians must also document everything - the patient record should reflect whether a patient refused proper screening tests, as well as whether the patient understands the potential consequences of that choice. To learn more about the possible implications of high-deductible insurance on medical malpractice, contact us now.
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