Unintended Consequences: How HIEs Force Patients to Quit Their PCPs

Last week, a patient who has seen me for more than 20 years called my office for an appointment. She signed up for one of the new HIE insurance plans but we are not a provider on that plan. She is a healthy woman, rarely needing my services and expected her new insurance to be her backup in case she became seriously ill. She was willing to pay cash to see me but this is unacceptable under Kentucky rules and considered “insurance fraud.” The reason given to her and our legal representative, by the Kentucky Healthcare Exchange (KYNECT), is that if a patient can afford to pay for a routine doctor visit then they shouldn’t need insurance.

What? How does that follow? Since when does the ability to pay cash for a single visit mean that a devastating diagnosis and subsequent treatment would not wipe a patient out financially? One would assume lessoning that risk would be one purpose of the new insurance exchanges given that medical bills are the #1 cause of bankruptcies[1]! Insurance doesn’t need to be for routine visits. In fact, the entire basis of the DPC movement (Direct Patient Care) is to cut out the middleman of insurance from routine primary care visits.

Because I work for a healthcare system, my staff could not tell the patient what physicians and healthcare advocates “in the trenches” recommend, which is to hide your insurance status from your doctor’s office. There’s a great article entitled “Insured Patients Can Save Money by Pretending to be Uninsured” from the The Self Pay Patient website that explains how this works to many patients’ advantage.

I wonder, is this solely a Kentucky problem or is this an issue seen across the US? If anyone knows please leave a comment in the section below. In the meantime, if you are my patient and I don’t accept your new KYNECT insurance, well, I’m just sayin’…

1. LaMontagne, Christine. NerdWallet Health. http://www.nerdwallet.com/blog/health/2014/03/26/medical-bankruptcy/

HIEs say no / shutterstock