"I Can't Afford to Get Sick" (page 3 of 4)

Physician's Dilemma

Ask a doctor today about the satisfaction of practicing medicine and you're likely to get a litany of grievances -- most of it about insurance.

For many, the burden of malpractice liability insurance tops the list. In 2004, the average jury award in a medical- malpractice suit reached $600,000, and awards exceeding $1,000,000 have become common. This "jackpot justice" slams doctors who are in high-risk specialties, like obstetrics and orthopedics, with exorbitant insurance rates -- in some cases as high as $200,000 a year. In the last few years, around 150 physicians in West Virginia have closed their practices in the state, and Philadelphia has lost some 450 doctors. The AMA says malpractice pressures have put 21 states -- among them, Illinois, Florida, Ohio, Pennsylvania and New York -- in danger of serious doctor shortages.

Then there are bureaucratic hassles. "Insurers deny claims for so many reasons. They need a treatment code num- ber, or the documentation wasn't right, or they didn't give prior authorization," says Dr. Jonathan Walker, a psychiatrist in Bethesda, Maryland. "It's a huge waste of time for doctors, and it's time subtracted from patient care." Dr. Walker has come up with a solution that more and more of his colleagues are embracing: He simply doesn't take insurance.

"The uninsured have always been a problem," says Bob Crittenden, a primary-care doctor at the University of Washington. "But the underinsured are a faster growing problem by far." Crittenden says he's been forced to compromise care -- from mundane to serious lapses. "We put off things; we don't order tests," he says. "It's terrible."

So doctors face an uncomfortable choice: Either turn away patients with outstanding bills, or see their income slide. Dr. Donald Sewell, a retired gynecologist in the Washington, D.C., area, saw his practice make no profit at all in 2001 and 2002, his final two years. He had to bill patients directly for their share of the cost of each visit, and often he'd never see the money. "You'd send out bills and get maybe 20 percent back," he says. "It almost wasn't worth the cost of postage."

Administrative costs also rise with complex cost-sharing insurance plans. (By the time he retired, Sewell needed seven administrative assistants for his one-man practice.) So some doctors now refuse to see patients with outstanding balances or ask for the co-pays upfront. As a result, a new phrase has entered the medical vernacular: "co-pay or go away."

As consumers continue to fight for coverage while picking up more and more of the tab, they do the next logical thing -- delay. By the time they're compelled to seek treatment, they're far more expensive to treat.

Michelle Maclin discovered this the hard way. When her son Timothy, then 6, was diagnosed with severe asthma, her doctor produced a stack of prescriptions needed to keep him breathing. When the pharmacist came back with the price of her first co-pay, Maclin says, she just stared. "$348," she recalls. "I just sat there. $348." Then came the frequent doctor visits, at $25 a pop. Soon after, Timothy's 8-year-old brother, David, began having severe allergic reactions to everything from grass to pets to food. She was now buying medicines, tests, and doctor visits for two.

Their condition, she says, was terrifying; in a split second, Timothy might be struggling for air, and David would become swollen like a balloon. Just as quickly, it seemed, Maclin had blown through her savings and found herself thousands in debt. Soon she was compromising on their care. Timothy required weekly allergy shots, which she discontinued because she couldn't make the payments. And if David had an allergic reaction in the middle of the night, she thought twice before taking him to the emergency room, the $200 co-pay looming large in her mind.

Both her boys are doing okay, but Maclin carries guilt for even considering her bank account before their well-being. "You start to feel like a bad mother," she says. are there answers?

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