A Question of Ethical Referrals

[gmveesaert]

I was in the doctor's office and while the head nurse was filling out paperwork, we were discussing the politics of health insurance, as probably everyone in any field related to healthcare is right now. She was lamenting that the office's aging patients could really use an advocate and I replied that I agreed and was heading in that direction as a producer. She asked me what I thought she should tell her patients, most of whom are on Medicare & getting screwed on their medication coverages. (Separate thought: who the hell thought it was a great idea for them to be able to drop coverages with no notice?!)

I told her that because each person's health situation & list of medications is different, there really wasn't any one thing I could give her to pass along that would help them. What they need is an insurance agent to sit down with them and wade through the muck & figure out what fits their needs. She asked if I would want to do that for them.

If they give my card to other patients, I don't see an ethical issue arising from my also being a patient as long as no discussions take place between us about the mutual client. The guy who services my car occasionally sends me a client for P&C, and I see this as no different as far as my moral compass goes. Just thought I'd see if you guys agree.

Thanks for your thoughts...
Gina

 

[VaDwayne]

I was in the doctor's office and while the head nurse was filling out paperwork, we were discussing the politics of health insurance, as probably everyone in any field related to healthcare is right now. She was lamenting that the office's aging patients could really use an advocate and I replied that I agreed and was heading in that direction as a producer. She asked me what I thought she should tell her patients, most of whom are on Medicare & getting screwed on their medication coverages. (Separate thought: who the hell thought it was a great idea for them to be able to drop coverages with no notice?!)

I told her that because each person's health situation & list of medications is different, there really wasn't any one thing I could give her to pass along that would help them. What they need is an insurance agent to sit down with them and wade through the muck & figure out what fits their needs. She asked if I would want to do that for them.

If they give my card to other patients, I don't see an ethical issue arising from my also being a patient as long as no discussions take place between us about the mutual client. The guy who services my car occasionally sends me a client for P&C, and I see this as no different as far as my moral compass goes. Just thought I'd see if you guys agree.

Thanks for your thoughts...
Gina

(Separate thought: who the hell thought it was a great idea for them to be able to drop coverages with no notice?!)

Huh?

 

[briko3]

Sounds good to me. You both want what's best for the patients. Just can't talk with eachother about the specifics of the client.

 

[souldeux]

I have a similar relationship with a doctor's office in the Metro area. I did their group, and a couple of their receptionists hand out my cards to patients who need insurance help. The important thing about our relationship is that the patients call me - the doctor's office never tells me they've handed out a card, and they never provide any information about the client. All I ever see is that once in a while, someone from down there will call me.

I don't do anything with Medicare, though, so I am completely unaware if there are additional considerations there.

 

[BNTRS]

Sweet deal, good luck with it.

 

[Winter_123]

I was in the doctor's office and while the head nurse was filling out paperwork, we were discussing the politics of health insurance, as probably everyone in any field related to healthcare is right now. She was lamenting that the office's aging patients could really use an advocate and I replied that I agreed and was heading in that direction as a producer. She asked me what I thought she should tell her patients, most of whom are on Medicare & getting screwed on their medication coverages. (Separate thought: who the hell thought it was a great idea for them to be able to drop coverages with no notice?!)

I told her that because each person's health situation & list of medications is different, there really wasn't any one thing I could give her to pass along that would help them. What they need is an insurance agent to sit down with them and wade through the muck & figure out what fits their needs. She asked if I would want to do that for them.

If they give my card to other patients, I don't see an ethical issue arising from my also being a patient as long as no discussions take place between us about the mutual client. The guy who services my car occasionally sends me a client for P&C, and I see this as no different as far as my moral compass goes. Just thought I'd see if you guys agree.

Thanks for your thoughts...
Gina[/quote


It could be okay as long as the elderly clients don't end out thinking that they are talking with the lady who works down at the doc's office or that the doc's office wants them to see you as part of seeing them. They would not have that confusion if being referred by the guy who services your car but could with your doc.

Also be careful about where you meet with the clients given the prohibition about speaking with clients in waiting rooms, or areas where they receive care.

Methinks.

 

[gmveesaert]

(Separate thought: who the hell thought it was a great idea for them to be able to drop coverages with no notice?!)

Huh?

I read somewhere that they could do that; perhaps it was old info, an oversight when Part D first started that they since fixed? I thought that sounded screwy when I read it. I just went to the NAIC website, I now know 60 days notice is required for formulary changes.


The rest.... thanks! Yes, I figured I'd be going to visit anyone who called. I know that generation feels much more comfortable face to face and coming to them should eliminate any confusion that I don't work for the doctor's office or hospital. Good call, I'll be sure to make that very clear straight off.

 

[gmveesaert]

(Separate thought: who the hell thought it was a great idea for them to be able to drop coverages with no notice?!)

Huh?

I called Frank yesterday & he said that the ins. cos. can and do change formulary coverages without notice. That's just wrong, on so many levels.
I wonder if the bleeding hearts put that in their healthcare reform list.

 

[somarco]

Formulary's and par providers do change rather frequently on under 65 major med as well as Med supps. Not much you can do about it. When pharma decides they no longer want to offer discounts not much a carrier can do. Same with providers who decide not to renew.

This is not a health care reform issue. It is free market at work.

 

[gmveesaert]

This is not a health care reform issue. It is free market at work.

I have to disagree with that. The government can, and has, stepped in and regulated so much of our "free market" over the years. I think it's stupid that they don't protect the elderly people who helped make this country was it is today when it comes to their medications. It may sound naive, but in my opinion, surely an 85 year old getting their necessary medications is just as big a "right" as low income people having a roof over their head.

Of course, the insurance market in general is top loaded. The people in the most need are usually the ones that can't afford it. Look at LTC... I read just yesterday that the market for this product is people with substantial assets, but the people without substantial assets are the ones who will have the most trouble affording LTC costs later in life. It just seems backwards to me.