It was a routine visit to my barber, Carmine, who in spite of being bright and a good barber still thinks Dr. Levine is an Italian brother of his; likely because my Brooklyn accent confuses him. Carmine and I usually discuss topics that include how horrible the Knicks or Mets are playing and then get around to finding solutions to major political crises, global warming and eventually the problems with healthcare or what I jokingly call it: the health-not-care system.
But last week was a special day for us because Carmine told me he had “some type of test at my doctor where I looked at blinking lights.” To me it sounded like a study called Videonystagmography; better known as a VNG exam. This test is supposed to be used to look for reasons why a patient has recurrent dizziness but seems to be ordered by some physicians as a means of improving their bottom line.
“Did you complain of feeling dizzy, Carmine,” I asked? “No, but the doctor said, ‘Don’t worry about it your insurance will pay for it.’” Recently I had a chance to walk into that doctor’s office and noticed he had a room full of “Don’t worry about it your insurance will pay for it” testing devices. What is the ultimate insult to me is that this doctor is flourishing under the current healthcare system while qualified and honest physicians are paying for their colleague’s dishonesty.
On that same day an angry man walked into my office to seek a second opinion from me. “Doc, I saw this nasty heart doctor who told me I must have a nuclear stress test. When I told him I didn’t think I needed it he just said, ‘Don’t worry about it your insurance will pay for it.’” The man had neither symptoms nor any other reasons that would necessitate an expensive nuclear stress test and he was smart enough to know that. He told me he walks two miles a night and never got short of breath or had chest pain and that he was not concerned about the cost of the test but was troubled by the idea of having a radioactive substance put in his body.
When he showed me a copy of his consultation report, which was sent to the patient’s internist, it noted that a nuclear stress test should be done on the patient to determine the patient’s risk for coronary disease. To the average person, this type of conclusion might make sense and even to the average physician it would seem plausible. Yet the truth, based on several well designed patient studies, is that there is no justification to do a nuclear stress test on someone without symptoms and without real risks of having a heart attack – possible rare exceptions being older airline pilots. And since many insurance companies require the doctor to get a preauthorization for this study prior to performing it, I suspect the doctor may have lied as a means of getting the OK to do this nuclear stress test. In other words, he likely committed insurance fraud.
I knew the heart doctor he had just visited and knew him to be a duplicitous character who, had he not turned to the dark side, might have been a good doctor. I knew he made a very good living, far better than I did, doing what he did best — performing expensive tests on patients who didn’t need them. I reviewed the patient’s records, examined the patient and told him to go enjoy life, without the unnecessary nuclear stress test.
The practice of “Don’t worry about it your insurance will pay for it” is costing all of us in higher premiums and reduced salaries (if the cost of healthcare to your employer goes up it will eventually affect your compensation in other areas). And, because millions are on government administered healthcare, the practice is also responsible for increasing taxes and decreasing government services. To think that you shouldn’t worry because “your insurance will pay for it” is like thinking that you know a lot about Russia because you live in Alaska – it’s just dumb!
The “Don’t worry about it your insurance will pay for it” practice of medicine not only hurts your pocketbook but also all the honest doctors out there. Because of the epidemic of unnecessary and expensive testing, insurers have fought back to prevent their loss of profit by lowering reimbursements to their physicians. When this plan didn’t provide enough reduction in cost the insurance industry began making it very difficult for anyone, even if they really required it, to get just about any expensive test; they hired companies to be gatekeepers and created a difficult process for doctors to get approval to perform tests on their patients. Now “Don’t worry about it your insurance will pay for it” increases your insurance premiums, likely hurts some patients (all tests have some inherent risk), hurts all the decent doctors out there by diminishing their reimbursements while making it more difficult and costly for your physician to perform the study, and makes it harder for you to get a test that could save your life.
When you hear a physician tell you,”Don’t worry about it your insurance will pay for it,” don’t be afraid to question your physician further about the need for the test. If you don’t get a satisfactory response, leave the office, consult another doctor, or consider contacting your insurance company or even the Office of Professional Misconduct. We are all in this together now, soon more than ever, with the passage of the Affordable Healthcare Act, and we need to be responsible citizens.
Dr. Evan S. Levine is a cardiologist in New York and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.