Balance Billing

There's been a lot of talk lately about the practice of balance billing, especially in California. Balance billing occurs when a doctor charges more for a service than an insurance company is willing to pay, and thus the doctor charges the patient (illegally) for the balance. While I certainly believe that the practice is unethical if it is prohibited and patients don't know any better, is it really that unfair? Doctors put a lot of work into doctoring... shouldn't they be properly compensated? Should they really be just barely covering the costs because people buy small insurance coverages or because Medicare/HMOs are too stingy? In the case of a patient in need of emergency care that the insurer wouldn't cover, balance billing is unethical. Agreed. But what about otherwise? Nobody seems to be pissed at their insurance company for this... just at the doctors for being audacious enough for asking for what they charged. It's tantamount to paying a $1 for a $5 loaf of bread and saying that you really needed it, so the store should just give it to you. This never happens with other professionals - could you imagine winning a court case (like having a successful surgery) and not fully paying your attorney what he was due? Dr. Atul Gawande, author of Complications and Better, has made this argument before. Maybe going into the profession I'm sort of biased toward protecting doctors from the flak they get these days, but at the very least the blame should be shared with short-changing insurance providers?

Health Law Conference

Yesterday I had the pleasure of attending a Health Law conference for professors (I got a special registration) held at Drexel University. It was quite interesting, though I was not able to attend too many of the sessions. Either way most of it would have been legal jargon and over my head, but it is nice to think of lawyers as something other than blood sucking parasites that ruin doctors' lives, as they are usually portrayed. Rather, it seems that most lawyers in the health field genuinely care about patient care, human rights, and global health just like physicians and nurses do. They ponder deeply about bioethics and new and emerging problems, sculpting the law to be able to tackle these novel issues. What I found most interesting yesterday was something that I had heard about in the news but only really heard in detail about yesterday during one of the plenaries. Supposedly, many people have been requesting voluntary amputations of either their legs or arms for reasons such as "it doesn't feel right on my body" or "I would feel freer without it". Is it legal and ethical for a surgeon to provide such a service? It is similar to part of the testimony delivered in Roe v. Wade, since home abortions were extremely dangerous and attempted far too routinely. One can only imagine the horrors of a botched home amputation.