How Patients' High Deductible Insurance Plans Pose Malpractice Risks to Doctors

High deductible insurance plans require patients to take on more of the financial risk in exchange for lower monthly premiums.  Patients are increasingly choosing plans where they cover their own eligible expenses until costs reach a deductible that can be well into the thousands of dollars.  These high deductible insurance plans can pose a malpractice risk to doctors.

The number of patients with health insurance has increased due to the Affordable Care Act, however, most of these patients choose high deductible health plans.  The number of patients with these types of plans has increase to 17.4 million in January of 2014, up more than 12 percent from the previous year, according to Healthcare Finance.

The issue that physicians are seeing with these high deductible plans is that patients are making medical appointments less often for chronic care, and are also skipping medication refills or declining to pay their out-of-pocket costs for medical tests.

Patient choices to forgo aspects of their health care can have disconcerting implications for physicians.  A case reported in Massachusetts Medical Law Report demonstrates these potential consequences.  A physician was sued for malpractice by the family of a patient who died after a late stage cancer diagnosis.  The patient, a 65-year-old man was a patient of the physician for four years; however the physician never performed a complete physical exam during that time, including colon rectal cancer screening.

The cancer was not diagnosed until the patient went to the hospital with abdominal pain for several hours and no bowel movement for several days.  He underwent exploratory surgery where stage IIIB colon cancer was discovered.  The physician said he did not offer the patient cancer screening because he was only seeing him for blood pressure checks, not for full primary care.  The private-pay patient declined any further medical care beyond those blood pressure checks.  The case ultimately settled for $1.5 million.

The risk stems from the fact that physicians could be held responsible for patients who decline care and this risk is likely to increase as patients put off or skip screenings that are not covered by insurance. 

To protect themselves, physicians must explain the risks of skipping tests and then follow through on whether they have been performed or not.  Physicians must also document everything – the patient chart should reflect whether a patient declined appropriate screening tests, as well as whether the patient understands the possible consequences of that decision.

To learn more about the potential implications of high-deductible insurance on medical malpractice, contact us today.