Mary Lewis, Esq.
More and more of my clients are being turned away by doctors when seeking treatment for injuries incurred in automobile collisions. What seems to be a growing trend for doctors’ groups adopting blanket policies against treating patients injured in automobile collisions is creating a real problem for these patients who genuinely need treatment and are having increasing difficulty finding it. For the doctors turning them away, it does not appear to matter the nature of the injuries sustained, the specialty of the medical group, whether or not the patient was a long-time patient of the practice, or whether or not litigation is involved. Nor does it seem to matter whether the patient has health insurance, Medicare, Medicaid or PeachCare, which would cover the cost of the treatments sought. Based on my personal observations, the problem is widespread and not limited to a few areas of practice. My clients have encountered it when seeking care from orthopedic, neurologic, surgical, physical therapy, general, and pediatric practices.
When I initially encountered this problem, I was equal parts bewildered and outraged. My first thought was, what about the Hippocratic Oath, the last line of which currently reads: “May I always act so as to preserve the finest traditions of my calling and … long experience the joy of healing those who seek my help”? Wouldn’t part of preserving the finest traditions of your calling include treating patients who need and are actually seeking your help? What difference should it make whether those seeking your help incurred their injuries in a fall down the stairs at home or in a car wreck on the interstate?
It didn’t make sense to me, but at the same time I knew there must be a reason, and that the reason was probably not based in some random and irrational dislike of people injured in car wrecks. After researching the issue and discussing it with other attorneys encountering the same problem, I find a few possible explanations have come to light; however, there does not yet seem to be a clear consensus on why the aversion to car wreck injuries is happening.
One possibility is that the hassle factor alone might be discouraging doctors from becoming involved. Car wreck cases sometimes do lead to litigation and doctors have busy practices. It is understandable that they might not want to be pulled away from those practices to be deposed or to testify at trial. Although doctors bill for their time when called to testify in these contexts, it is entirely possible, notwithstanding being paid, that many would rather not have to participate at all. For that reason alone, they might be turning away automobile collision patients. Still, I personally do not believe that is the primary reason.
I believe that the far more likely cause is economic, based in the fear, reasonable or not, that they will not be paid for their services when they treat auto collision patients. According to some, health insurance providers are refusing to pay doctors for treatments rendered to their insureds for automobile-collision-related injuries, taking the position that they are not responsible since there is potential third-party liability. If this is true, it is understandable that doctors might want to turn away these patients. However, if this is the message doctors are receiving, it is likely they are being misled.
Managed care networks, including HMOs, PPOs, and the like, are governed by contracts that set forth the various rights and responsibilities of all the participants in the network. Under these contracts, patients are required to use only the limited number of doctors within the network (or forgo benefits); doctor are required to provide appropriate treatments to patients who participate in the network; and insurers are required to pay for those treatments. While an insurer might be entitled to seek some reimbursement from the proceeds of a potential third party suit, the insurer should not refuse to pay a doctor for their services, whether before or after rendered. Medicare, Medicaid, PeachCare and other government-sponsored programs similarly come with rights and obligations for participating members.
While I do not profess to be an expert on the precise rights and responsibilities inherent in any of these insurance programs, it is clear this is a serious and growing problem for which a solution needs to be found. It is not acceptable for patients to be refused necessary treatment by the doctors they are mandated to see, nor is it acceptable for the doctors who render those treatments to be denied payment. Before a solution can be found, however, the causes need to be more clearly identified. For my part, I intend to contact providers who are turning away my clients and try to find out what their concerns are and the basis for those concerns, and try to secure treatment.
I would encourage other attorneys who are experiencing this problem to do the same. I welcome any other suggestions others might have for how to resolve this issue. Perhaps together we will be able to come up with a solution that will ensure that patients get treated, doctors get paid, and our managed care and government-sponsored health-care programs will work as they are intended to work.
Mary Lewis, founder of The Law Office of Mary D. Lewis, LLC, dedicates her practice to personal injury and workers’ compensation law. Prior to her admission to the Georgia Bar, Ms. Lewis gained an appreciation and passion for the legislative process, in part, through her opportunities working in various capacities for legislators in both the Georgia House of Representatives and in the U.S. Senate.