The myth of “patient wishes” and HB 562

May 07, 2019

HB 562, which could cost North Carolina as much as $2.2 billion, was rightfully not given a favorable report from the House Insurance Committee after a heated but respectful discussion from the members of the committee. 

One of the arguments advocates made in favor of the HB 562 is that it mandates that “patient wishes” are respected. So what wishes are they talking about? The apparent “wish” is for the patient’s insurer to send a reimbursement check to an out-of-network provider rather than to the patient.   

There are reasons patients should not “wish” for this.

And how do patients express that “wish?” It’s a line on one the forms that you sign when you go into the doctor.  Now we know that we should all read every line of everything we sign, but we also know that in reality most people don’t read the fine print.  And those who do, don’t always understand that they have a choice to push back on parts of the contract.

And frankly, one may not be inclined to negotiate the fine points of an emergency room form when one is facing a medical emergency.

So it is dishonest to say that any time any patient signs a contract they are expressing their “wishes.”

But let’s look at the best case circumstance. What if the patient is a) literate in the complex language of health care, b) comfortable reading the fine points of contracts and c) familiar with the phrase “assignment of benefits?”

Let me tell you my story about my own “patient wishes.”

This is a picture of a bandage I received after slicing off a portion of my thumb last year. I was traveling in one of the states that has a government mandate that “patient wishes” are honored.

I drove to an urgent care facility. At the front desk, they give me a clipboard with a bunch of forms to sign. Though I am bleeding profusely, I am lucky to be right-handed so I can sign them without too much trouble. Unfortunately, flipping through the pages is difficult and I’m worried time is of the essence. Despite this, I notice an “AOB” provision.  

I tell the person helping me that I don’t wish to sign it with that provision. She doesn’t even know how to respond because she is used to everyone just signing the form. The staff is very kind and professional, but they are completely unequipped to respect my “patient wishes.”

The person I’m talking to admits she doesn’t know what the form says and tells me most people don’t bother to read it.  She doesn’t know what “assignment of benefits” means. What she does know is that if I would just make her job easier and sign the form, she can get me care immediately.

Bleeding, light headed, and frustrated, guess what I did. I signed away my benefits – against my “patient wishes.”

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