Patients without adequate medical insurance are using every option available to get primary care services paid for. Those that have adequate medical insurance get their annual physical examinations covered without copayments, but usually make a copayment for sick visits. Medicaid patients have no copayments, at least in Florida. Some have large deductibles (Health Savings Account) and must pay full cost of services upfront. Those without any medical insurance have to pay cash or use a credit card. Many providers have offered free care to those lacking insurance coverage, and without the necessary financial resources.
Now there are a few other categories. There are some patients that have medical insurance policies that do not pay primary care physicians for ‘mental health services’. Even Medicare reduces primary care reimbursements, when diagnoses such as Anxiety or Depression are included. These are very common conditions, and it creates problems for patients and primary care doctors who do not get paid for managing them. How can a primary physician exclude managing these common complaints?
I have a 26-year-old patient whom I have been caring for since she was a child. A few months ago her medical insurance company stopped paying for her office visits that involved treating anxiety and depression. The severity of these conditions was mild and easily treatable by any competent family physician. There was no need to send her to a psychiatrist just because her insurance company capitated those services under psychiatry. She wanted me to continue treating her for anxiety and depression. I was therefore surprised a few weeks ago when she used her automobile insurance for an office visit. You see, several months ago she had a motor vehicle accident and suffered a mild back strain, which I believed had completely resolved a few weeks later. She said her back was still hurting and she believes that the accident is making her anxiety worse. Needless to say, she needed medication management and refills for anxiety. It was obvious to me that she was using her automobile insurance to cover medical care for anxiety, because her medical insurance would not pay me for this specific primary care service.
Another case involved a young man who recently came to see me for the first time. He used his automobile insurance stating the visit was for complaints related to an accident that involved only his motor vehicle several months ago. As it turned out, the reason for the visit had nothing to do with injuries related to an accident. He was really complaining about ‘anxiety symptoms and difficulty concentrating’. He wanted prescriptions for stimulants and alprazolam. I told him that using his auto insurance for these complaints was totally inappropriate. I also told him that under the circumstances, I would not immediately prescribe these controlled substances without appropriate clinical findings, past medical history, and documentation. He became very angry, abruptly walked out of the examination room, and left the office.
These two examples demonstrate the misuse of motor vehicle insurance for unrelated complaints. One case was because of inadequate medical insurance coverage, and the other was because of no medical insurance coverage. It is necessary for medical insurance to cover all standard primary care services, including treating anxiety and depression. Without adequate coverage, services are still provided in many cases, but physicians end up getting underpaid or not paid at all. In some cases automobile insurance companies bear the cost inappropriately.