Teaching Patients About Insurance: Should Docs Get Involved?

Larry Culpepper, MD, MPH; Robert W. Morrow, MD; Charles P. Vega, MD


November 25, 2013

In This Article

Editor's Note:
The Affordable Care Act (ACA) and the many changes it portends for healthcare are now here. The American Academy of Family Physicians has encouraged its members to "be prepared to discuss the insurance options available through the Marketplaces and encourage patients to make coverage decisions that are appropriate for their health care needs."

We wanted to know what practicing family physicians thought about this advice. So we asked members of the editorial advisory board at Medscape Family Medicine to tell us what they thought.

Our questions to them were:

How realistic is this recommendation?

Should primary care physicians be educating patients about insurance exchanges? Do they have the expertise? Even more important, where in a 10- to 15-minute patient encounter is the time to do this?

What about "conscientious objectors" who disagree with the ACA?

Three of our advisory board members shared their thoughts.

Responding to a Desperate Patient

Charles P. Vega, MD

Chuck Vega is Health Sciences Clinical Professor and Residency Program Director in the Department of Family Medicine at the University of California, Irvine, and maintains an active clinical practice.

I did not have to look to find the ACA. It found me recently in clinic.

I don't usually use anecdotes to address complex issues, but this one is particularly timely. We had a new patient, a middle-aged woman, come to our community health center. She had, unfortunately, been diagnosed with cancer only 2 weeks before her visit. The oncology department had seen her and laid out a plan for surgery followed by adjuvant therapy.

But the patient lacked health insurance. She saw someone in the clinic front office as well as a social worker, and apparently all that they could determine was that she did not qualify for Medicaid. The patient and her family were desperate.

To me, there was no greater priority for me as a treating physician than to get this patient help in covering the many thousands of dollars in medical bills to come. So I put the visit on hold -- no examination, just enough time to assess her emotional state and offer some support. And then off I went to explore the exchanges on her behalf.

I used the Covered California Website and toll-free number to get her information. I was disappointed to learn that coverage couldn't begin before January. However, she did qualify for a county program that will provide coverage for the next 2.5 months. And I provided her with the necessary information to apply through the exchange.

It was not a typical visit. These are not typical times. But it sure felt a lot better to be able to help someone in a situation that I've seen play out hundreds of times. Patients trust physicians to be their best advocate, and that supersedes any personal or political agenda on the part of the physician. It also means gaining some new skills and stepping out of your comfort zone when necessary.

Here's to being uncomfortable for all the right reasons.


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