Seattle Doctor Introduces Self-Pay Option

03/23/2009

Most people get health insurance through their employer. So when they're laid off, they lose not only a source of income, but medical coverage, too. In our ongoing coverage of how people are responding to the recession, KUOW's Ruby de Luna introduces us to a Seattle doctor and how he's helping patients who are unemployed.

Dr. Michael Rosenfield is a primary care physician at Emerald City Medical Arts on lower Queen Anne. About 9 months ago, he and his staff noticed some changes that caught their attention ... some regular patients stopped coming in, and others didn't even pick up their prescriptions. Rosenfield was also getting more emergency room reports. He remembers a patient who took her baby to the ER for an ear infection.

Rosenfield: "And I read the report carefully, and I kept thinking to myself, there's nothing here that would make me feel that it would be an emergent situation."

So when Rosenfield's staff called the mom to schedule a follow up visit with the baby, he learned why she went to the emergency room.

Rosenfield: "She had in fact lost her health insurance, and she felt that it wasn't appropriate for her to come in anymore because she felt that she wasn't going to be able to be seen because of lost insurance."

The family lost medical coverage when the father was laid off. It became clear to rosenfield the economy was affecting his patients, and his practice. He couldn't control the economy, but he wanted to help his patients and protect his business. After discussing the situation with his staff, they came up with a plan. So he sat down with his staff and discussed the situation, and came up with a plan. Last fall Rosenfield sent out letters to patients and introduced a "self–pay" option. In this arrangement, patients pay on a sliding scale. Usually they pay between $40 to $60 each visit.

Rosenfield: "Risha? Good morning. How are you?"

Risha: "I'm good."

Risha, who doesn't want to give her last name, has been Rosenfield's patient for more than a decade.

Risha: "When I got the letter I got a sense of relief, like I knew that was available if I really needed it."

Recently, Risha needed medical attention. She has a thyroid condition that she thought was under control. But lately she's been feeling tired. She had medical coverage when she was working as a product designer. But not anymore, not since she got laid off two months ago. Risha says she tried to put off dealing with her medical problems. She wanted to wait until her financial situation got better. But she was also scared of the things that could go wrong in the meantime.

Risha: "I kind of thought, what would I do if, you know…would our entire savings be wiped out because of one trip to the emergency room?"

Risha says she's thankful she can continue to see her doctor even without insurance. As for Rosenfield, he was bracing to take a financial hit with the new payment plan. But as it turns out, it's actually saving him money. It's reduced the amount of paperwork he has to file, and it's cut back the time he spends going after insurance for payment.

Rosenfield: "With the people that are coming in for this reduced amount, let's say they pay $50 when they're seen, that's $50 we can deposit into our account, without having to touch the account 5 times before getting reimbursed."

Rosenfield still encourages his patients to get insurance, if possible, especially for serious medical situations that would require hospital care. The reduced fee was borne not only as a way to protect business, but also to protect his patients. Rosenfield was afraid if his patients don't come in for treatment, their medical problems could get worse. He worries about patients with chronic illnesses like diabetes.

Rosenfield: "They would feel okay but their diabetes would be out of control and they wouldn't realize it. And they would end up with a sore on their foot and would have to have an amputation, they would have renal failure, these are people I have been taking care of personally for years and years and years. And to see that the potential for their health care to just fall apart would be devastating to me and to them obviously."

In the long run, treating the complications of diabetes is far more expensive than keeping the disease under control.

It's estimated that over half a million Washington residents are without health care. And that number is expected to rise in the coming months. Health programs for low income people are already strained, and with the severe budget shortfall, things could get worse. There's a lot of anticipation that money from the federal stimulus package will fill the gap. But it will take time before the funds make their way to communities, to the people who need them. Rosenfield says the reduced fee is his way of helping out, especially during these uncertain times.

Rosenfield: "Our job is to treat people not just for the laceration or for the diabetes, but to help treat the fear. And if we can do that by telling them you can come here, it's okay, we'll see you for an amount that's affordable then you've treated a part of what's wrong with them."

Since he started the self–pay option last fall, about 150 patients have used the new payment plan. But as layoffs around the region continue, rosenfield expects more patients will need the program. I'm Ruby de Luna, KUOW news.

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