My doctor’s office is becoming a medial boutique!
September 16, 2006 3:05 PM   Subscribe

Our doctor is dropping all insurance and Medicare participation but isn’t telling his patients until they show up at his office, or if they just happen to read his web site. Should we do anything about it?

My partner had a doctor’s appointment Thursday, and the doctor refused to see him. This is the primary care physician in Houston that we both have seen since early 2003.

I'll call him Dr. Voldemort; he’s a prominent local physician whose practice combines internal medicine, primary care, and HIV-related care. He has advertised for many years in the Houston Voice and OutSmart (gay rags) and has a number of patients with AIDS/HIV who are dependent wholly or partially on government assistance with their health care.

My partner has been HIV-positive since the early 1980s; he does not have full-blown AIDS. He has, for unrelated reasons, been on Social Security Disability with Medicare and Medicaid since the early 1990s. His medical problems and issues are legion. Since we moved to Galveston in 2002, he started seeking care locally at the UT-Medical Branch, then switched to private doctors in Houston seeking more proactive and less bureaucratic care.

We both have been seeing Dr. Voldemort since 2003. I am HIV-negative and basically healthy, fwiw, although I have occasional health-care needs. Voldemort and his staff have been generally helpful and have referred us to a number of incredible and gracious specialists in Houston who have provided some of the best care my partner has received in years.

Anyhow, it seems that during the summer of this year, Dr, Voldemort decided that he will be dropping all insurance, PPO, and Medicare participation. Instead, he is choosing to require patients to pay in full for services at the time of the office visit, and pay according to his fee schedule.

Although those changes go into effect October 1, his office staff would have required my partner to make a payment for the visit because the doctor has already stopped participating in Medicaid, which is his supplemental coverage for his Medicare. My partner could not pay the money, so he was turned away. Starting October 1, patients will have to pay up front and then submit claims to their own insurance. Under Federal rules, the ones who have Medicare will not be able to submit their claims to be paid, since Dr. Voldemort no longer participates in Medicare and does not accept the Medicare reimbursement level.

Although the doctor has a right to run his business this way, essentially turning it into a medical boutique, what we really can't understand is why he didn't notify his existing patients. When my partner was there Thursday, they were pretty rude about it. The doctor would not speak with him at all, and the office manager said that it was too expensive to notify their patients that the changes were happening. "This isn't a free clinic! We are salaried here!" What a snob.

So, my partner left. He was so upset that he got lost driving home. It's at least a two and a half hour round trip from here to that part of Houston, gone to waste, that could have been avoided. When he got home, I checked the doctor's web site and found a notice from July about these changes. They had weeks to let us know. At a minimum, his receptionist could have told my partner this was going on when he made the appointment. yes, I know I'm ranting...

The bottom line from all of this is that my partner will be able to continue with his existing specialists, just as before. One of them, the HIV specialist, will probably be able to pick up his primary care, although we need to check that out. We're still just stunned to see a business decision in a so-called "caring profession" communicated and handled in such a callous way. I can't imagine what the rest of Voldemort's Medicare patients will do, especially if they come in for an appointment after October 1 and suddenly discover that they won't be cared for.

So if you’ve made it this far, here’s the question: Should I do anything about this? Call the Houston Chronicle? The Houston Voice? Marvin Zindler? Anybody? I keep thinking of other people who will show up at Voldemort’s office seeking care, especially after October 1. They will be turned away because they can’t or won’t pay for the office visit. Especially the ones on Medicare, who are probably on a fixed income… I’m hoping that the ones who may have an HMO have received a notice from the HMO that their doctor will be “out of network” on that date. As a Voldemort patient, I have a PPO, and I have not received anything like that.

It troubles me. Do I have a moral obligation to tell someone? If so, who do I tell? Or is it o.k. to tell myself that with my partner’s poor health and many issues in our lives, that it is better to keep the obligation to ourselves to preserve our privacy? I especially do not want to identify my partner to others in the medical community as a potentially “difficult patient” who would make waves or get them “in trouble.” His medical needs are so pressing that maintaining the best relationship with his care providers is essential.

I want to make it clear that I think the doctor has a right to conduct his business as he sees best and make changes to his insurance affiliations or have none at all, if he wants. According to his web site, he believes that the U.S. medical system in broken, and he is opting out because he wants to provide a higher standard of care for his patients. That’s fine, if that’s what he wants to do, even if the only patients he will eventually care for live in River Oaks or West.U and drive Mercedes and Jaguars… My bone of contention is that he is not telling his patients in advance of doing so, and many will be left in the lurch.
posted by Robert Angelo to Health & Fitness (16 answers total)
Response by poster: Oops.... That heading should read "My doctor's office is becoming a medical boutique!"
posted by Robert Angelo at 3:12 PM on September 16, 2006

If this doctor has pursued the gay press in particular with advertising, I'd call those outlets and tell them about this, suggesting they do a story on it, just because of how particularly exploitative and uncaring that seems, but I'd also call other local papers and radio stations and tip them about this "healthcare system breaking down - + the human cost" story. This sounds like a good, solid local news/happenings story. It doesn't have to excoriate the guy, but it's a solid good piece of information with an opportunity for community resources to educate their audiences on the context and their options.
posted by caitlinb at 3:30 PM on September 16, 2006

Marvin Zindler's still alive?

I doubt any kind of "consumer advocate" would take much interest in this, considering that (viewed dispassionately), the worst he's guilty of is poor customer service that will end up being a (one-time) inconvenience to people.

It wouldn't hurt to fire off a few letters (the Houston Press comes to mind), but I don't think what's going on here warrants the energy you're expending being furious about it.

I'd also keep the class warfare talk out of any word-spreading you do -- I believe it badly undercuts your assertion that you really believe the doctor has a right to conduct his business as he sees best, and gives a "sour grapes" air to the whole thing.
posted by Doofus Magoo at 3:43 PM on September 16, 2006

Can't you speak to the press on condition of anonymity?

I'd be inclined to let people know, as it may take some time for people to find a new physician, and ongoing care is important for immunocompromised patients (whether because of HIV/AIDS, Hep C, or any other cause).
posted by Tuwa at 3:51 PM on September 16, 2006

Response by poster: I'd also keep the class warfare talk out of any word-spreading you do -- I believe it badly undercuts your assertion that you really believe the doctor has a right to conduct his business as he sees best, and gives a "sour grapes" air to the whole thing.

Noted. I know I have some "issues" here, since I'm calling him Voldemort. That's just being upset and angry, and venting in this particular forum. I wouldn't speak in those terms were I to approach the press.
posted by Robert Angelo at 4:11 PM on September 16, 2006

Can't you speak to the press on condition of anonymity?

You would probably have some trouble there, as a reporter would think that you might have a personal problem with the doctor and want to remain anonymous to be able to make accusations without the doctor knowing who you are. But you could talk anonymously, not get quoted in a story and hope the newspaper can find some patients who will talk on the record.

Is there some kind of group that helps HIV patients in your area? Maybe they can help you spread the word.
posted by Airhen at 7:02 PM on September 16, 2006

change doctors, forget about it
posted by caddis at 7:28 PM on September 16, 2006

Even doctors have bosses. Is Dr. Voldemort is part of a medical group or hospital? (Is his office in, say, Slytherin Medical Center or affiliated with Parseltongue General Hospital?) That's who you should complain to, not about the changes but of the lack of notification. Anyone in his practice should have been informed of the change, preferably in writing, well in advance so that they could find a new doctor if necessary. Any doctor who would fail to inform his patients obviously doesn't care one whit about them, so you're better off without him.
posted by Violet Hour at 7:45 PM on September 16, 2006

I think the Slytherin Medical Center is going to hear it, in the form of a trademark suit, from the revered Slytherin Law Center.
posted by caddis at 7:48 PM on September 16, 2006

Your state has a medical oversight board that regulates licensing and ethical violations. Your state has an attourney general and maybe a consumer rights advocacy office. There's a branch of the American Medical Association. Write a version of the story that is calmer, and send it to all of them. Better Business Bureau and Chamber of Commerce, too. Send it to the media where he has advertised. At the very least, you'll feel a little better, and maybe he'll face some consequences.

My previous doctor hated the insurance regulations, and found that he could do well and work fewer hours, in a medical boutique. But he notified patients beforehand.
posted by theora55 at 9:10 PM on September 16, 2006

my advice? ... advocate for a health care system that isn't so negligent and oblivious to the concept of caring for ALL people ... i think your doctor was rude towards his patients by changing his practice this way without notifying them and i do think on a *general* level, the idea of doctors moving to the boutique model is newsworthy, but quite frankly, he's merely the product of a byzantine and faltering system ... telling the press about *one* doctor isn't going to change much ... voting for candidates who are going to make true health care reform a priority may well change something
posted by pyramid termite at 9:22 PM on September 16, 2006

Um, he might have run afoul of Federal rules.

My understanding is he must give 30 days written notice to his patients that he will not be seeing them anymore (to allow people time to find a new doctor). I seriously doubt anybody will find "Duh, I put it on my website" sufficient for legal notices. The law does not care if it is expensive to send a bunch of letters with $0.37 cent stamps.

I'm not sure who you should talk to. Theora55 is correct that the AMA, the specialty board with whom this doctor is certified, the state AG, and the State Medical Board in particular are good places to start. Remember that MDs and DOs have different governing bodies when you get into this. If you are involved in an activist group (perhaps an AIDS help/support group?) they might have people who specialize in such things.
posted by ilsa at 9:41 PM on September 16, 2006

I agree with the people that say raise a stink about it in the press and with the AMA. Do it. Exposure is the best way to initiate change. Then switch doctors because I don't care how good he's been at finding you partner specialists, this doctor's a douche and doesn't deserve your business regardless of who is paying for it. There are lots of good doctors out there. In a city as large as yours I'm sure there is another that would provide just as good care.
posted by ChazB at 3:07 AM on September 17, 2006

Response by poster: Thank you all for your comments and suggestions. After another night’s sleep, I realize that a lot of my motivation came from anger and frustration. Having vented, I’m moving into problem-solving mode. I’m not that person who rants and raves instead of coping with life and getting things done.

My partner’s records are being sent to the HIV specialist who also does primary care – let’s call him Dr. Bones. Tomorrow we’ll call Bones’ office and set up an appointment. That day, I’ll go along with my partner and we’ll talk with him together. We will calmly explain that the reason for seeking this change is because of Voldemort’s new policy, and that we had not been notified in advance. The two of them are cross-town colleagues and have known each other for years. I hope that Bones would be willing to check in with Voldemort informally about the issue of patient notification. In other words, I want to believe that there are no real bad guys here. We need to simply work it out.

On a larger scale, I acknowledge the anger here. The thing is, if I reserved my anger for the bigger fights, the things that quote-unquote really matter, it would be so self-indulgent and all-consuming that I could not function. My energies would be drained away from the tasks, responsibilities, and worries that face me every day. It’s better for me to use people like Voldemort as my pressure valve.

Let me give you a glimpse into a world that Muggles don’t usually see. A decade and a half ago my partner could easily have been one of you, albeit prior to the Internet being generally available. He had a creative and good paying job, working as a photo-stylist for a San Francisco advertising agency. He lived in a trendy neighborhood (Castro), had disposable income, enjoyed the little luxuries that we used to take for granted (CDs, drinks, nights out…) and pretty much enjoyed the life of a typical gay man in the city. He was HIV+ and a lifelong Type I diabetic, but also was essentially healthy. Until…

Around 1991, I think, he had a surgical procedure where the staff failed to monitor his blood sugar properly. He had a crisis, and was in a coma two weeks. Upon his awakening, he was sick and weak, and has never fully recovered. He lost his job. He went bankrupt. Family members advised him not to file a lawsuit; I’ll never understand why. He went on Social Security Disability. Although he made a few attempts to return to work, he was not healthy and strong enough to keep a job.

Forward to 2000, after several long-distance moves for both of us, our paths crossed in San Diego. Love at first sight. A few months later he fell off a ladder at my house. A shattered heel and several operations later, there are days when he can hardly bear to walk. We moved back to Texas, my home state, in 2002.

Since then… There was that time I woke up in the middle of the night to hear him moaning incoherently; his blood glucose level was in the upper 20s. A couple of bottles of orange juice saved him a trip to the ER. I realized that night that the only time he and I have together is now. We won’t have the years of companionship and travel together that we longed for. “No day but today,” as the song goes.

Now, every single day is a challenge. When he gets up in the morning, I don’t know if he’ll be able to be active. I don’t know if he’ll be able to eat. If he has a doctor’s appointment in Houston and is healthy enough to drive there by himself, I wonder sometimes if he’ll make it back. In January, for example, he drove up to Houston for a routine appointment and ended up at the ER and then a week in ICU with diabetic ketoacidosis. That drive up to Voldemort’s office last week was a major effort for him, and left some pressing health issues unaddressed. But we’ll handle it.

I’m lucky that I’m self-employed and work at home. It allows me maximum flexibility to manage whatever life throws at us. I’ll wrap this up now. Again, it’s getting self-indulgent for me to rattle on here; it’s not my blog. I do appreciate your support and advice, and the chance to vent.
posted by Robert Angelo at 7:37 AM on September 17, 2006

Not to excuse any of the behavior you and your partner have experienced, but is it possible that the doctor is unaware of his staff's failure to properly notify you of the change in payment rules? I once had a receptionist at a doctor's office tell me that my doctor had said something he never actually said about my care. I wrote the doctor a letter asking him to explain the policy, and the doctor called me and told me that not only was that not his policy, but that he had no idea that his receptionist was telling patients what she was. It turned out that she was basically lying to patients because she didn't want to fill out the extra paperwork it would take to actually do her job properly.

I agree with all of the posters who say that the next logical step would be a letter to the licensure boards with whom the doctor is certified. But before doing that, I'd write the doctor a letter explaining your disappointment with his staff's failure to notify patients, and give him a chance to respond. It may be that he relied on his staff to notify patients and is unaware that they've been relying on the website to do so and have been failing to tell people who make appointments about the new policy.
posted by Amy Phillips at 7:40 PM on September 17, 2006

« Older Meat Slicers?   |   Til Death Do Us Part..maybe... Newer »
This thread is closed to new comments.