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Ethics Question - Heather

Posted: Jan 14, 2012

Is it illegal, or unethical, for a provider to talk about the patient's health insurance coverage, whether or not they're able to pay, in their medical report?

I don't think so - anon

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but don't quote me on that. I would have to say it's probably not illegal, since that information is located elsewhere in the record. I do work for a Dr. who will occasionally make comments like "recently unemployed" or "Pt has no health insurance" during the HP, but only in the context of how it is affecting the patient's stress level. I haven't had any personal problem with it, but again, I know why he put it in there.

What did your Dr. say that's making you wonder?

No, I don't think so, it is part of the medical - sm - Zorro

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record. As long as the doctor is not making fun of the patient or being degrogatory toward the patient. I just had a doc dictate that they could not treat the patient as the patient did not have insurance. I forget how he phrased it. I was a bit surprised as I know this hospital will treat those w/o insurance but presume it had something to do with his illness (and treatment) that made it very expensive for the hospital to eat, so he was to be referred elsewhere. They also put in treatment is on hold until the patient gets their insurance re-activated/activated, on unemployed, or does not meed Medicare requirements, etc. But don't see how it is illegal to put the fact of the matter in the patient's note as it is a big part of what treatment they can or cannot do.

Obviously if the doctor is gabbing to a bunch of other doctors, friends or family who have utterly no connection (the docs that is) then yes that would be unethical and a HIPAA violation for sure.

Heather - Old Pro

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No, it is not unethical. I know someone who is going on Sustiva (at a cost of $1420 a month) and you can bet discussions have been held with the doc about the patient's insurance.

I would think for liability reasons it would - be very important for

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them to include this information in a chart. Unfortunately, this can determine what kind of medical care is available for them. This should be noted so that if the patient does not have labs, imaging, surgery for this reason the doctor is somewhat covered. Most physicians, laboratories, hospitals are for-profit business. The physician I work for won't even see self-pay patients.

Unfortunately enough - Old Pro

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The most important medical "test" today is the wallet biopsy. Those who can afford it get care, those who cannot, good luck. The system is seriously flawed. I have a private physician who does not take insurance at all. He is a boutique physician and you pay per visit right out of your own pocket. The disadvantage: It is veeeery expensive. The advantage: You get a whole hour with him and you can spent it on dealing with your medical issues instead of spending time on how to manage insurance issues. But this system is not fair, because few can afford it.

Whoops! - Old Pro

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Before the grammar cops nail me, I meant to say SPEND, not SPENT. Still early for a Saturday on the West Coast and we are out of coffee!

No, it is not illegal or unethical - RHIA

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It is not illegal or unethcal for a provider to do that. Administrative information goes in the administrative record, kept separate (the left side of the folder or its EHR equivalent), but providers can tak about it in their documentation. There may be medical reasons for doing so, perhaps the patient is resisting needed treatment because of an inability to pay for it or a provider needs to find a source of lower cost medication. There could be perfectly tacky reasons, too, but bad taste is not necessarily illegal.

Providers should pay cose attention to what goes in the medical record, since those records can end up in court. Facilities keep an eye on this since inflammatory or inappropriate statements reflect badly on the facility, as well as the doctor. A statement that an uninsured patient waited too long to seek treatment for his chest pain due to the expense and it is too late to dissolve his clot would be ok, but calling him another @#$%! uninsured loser parasite would be something the HIM folks would want to address.

How you deal with inflammatory or inappropriate dictation like that will depend on the kind of job you have. You will not be held responsible for transcribing it. In some situations you might be able to omit it-I was able to do that and did so often. If you are verbatim just type it. If you can alert HIM, do that. I did that a few times with satisfying results.

If you work directly for someone who s unpleasantly inappropriate and are not comfortable talking to them about it, do not feel that you must say something. You are not responsible, they are.

But we all know that... - NotDone

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"Providers should pay cose attention to what goes in the medical record, since those records can end up in court. Facilities keep an eye on this since inflammatory or inappropriate statements reflect badly on the facility, as well as the doctor."

But we all know that increasingly this is NOT being done. Heck, most docs nowadays don't even read their reports before signing them, and the facilities sure as heck aren't reading them unless there's a transfer or a consult.

unethical? - EJ

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Not to change the subject, but I had a doctor who put so much unnecessary information into the record that I thought he was just being a social climber. Like mentioning that the pt was just back from some expensive vacation or owned such-and-such property or businesses. OK if the vacation was the source of the pt's condition, but otherwise it's just silly! I have also had a lot of doctors mention that the pt had no insurance or was waiting for insurance to get the medication, or that the preferred medication was not allowed by the insurance company, or that the pt was referred to the state for coverage. Doctors can't work free.

Excellent answer, RHIA. If unethical to mention money, - how much more to actually bill it? :) NM

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