A Whitehorse psychiatrist says he may be forced to close his practice as soon as this summer if the Yukon government’s health insurance unit continues to ask for patient files before processing his invoices — files he refuses to hand over because of privacy concerns.
In an interview March 12, Dr. Armando Heredia, who’s been practicing in Whitehorse for 15 years, said he recently began calculating how much money he’s owed by insured health services, part of the department of health and social services. Early estimates suggest that there’s more than $200,000 in unpaid bills, and that’s only for his services dating back to 2013.
“We’re at a financial point where we’re breaking…. Nobody can take a hit of over $200,000 and just walk away, and just say, ‘Oh, we’ll just keep going,’” Heredia said.
“If we don’t resolve this, (the closing of the clinic will) be before the middle of the year, easy. And I’m talking, I have a lot of patients I’ve seen here for 15 years that I won’t have a place to see. I won’t have a place to see them. It’s serious.”
Heredia has been locked in a years-long battle with insured health services over whether the unit is asking physicians to hand over sensitive patient information to verify certain bills. The government has previously denied asking for complete records, saying that it’s seeking evidence that a patient was referred to a physician’s care.
Heredia, though, has told media on multiple occasions that he’s received responses to bills requesting patients’ charts, notes and assessments before payment is issued. He told the News he’s “never” provided that information to insured health services when requested and as a result, doesn’t get paid for those bills.
He added that he’d rather have it that way, though, than violate his patients’ expectations of privacy and risk the sensitive information they disclose to him falling into the wrong hands.
“How is telling somebody the details of a rape or the aftermath, or consequences of post-traumatic stress disorder, how is that in any way, shape or form give them the information they need to run a bill, to run an invoice?” he asked.
“There’s a difference between me sending the information to another hospital or to another physician for the purposes of treatment and information that goes to the government for purposes of billing. The doctor needs the medical information. The government doesn’t. The government needs to know that there were services provided and the client was seen to safeguard and make sure there was no fraud or those kinds of things, but they don’t need to know what somebody’s grandfather did to them when they were six years old.”
The clinic’s financial reality is looming, though, and Heredia began sending letters to patients informing them of the situation March 3. Attached to the letters are breakdowns of the psychiatric services they’ve received, and which services have not been paid by insured health.
“This information letter is simply that, information to you, out of respect,” the letter read in part. “It is not, at this time, a bill. That said, as these unpaid fees mount over time and with hundreds of our patients, the overall amount has become significant. There may be a time when you will be issued a bill.”
Heredia said he doesn’t know when and if he would start issuing bills to patients, but if he does, it would be his “last resort.” About 15 letters have been sent out so far, he said, and have been mailed to patients as they come in. In total, he expects to mail out over a thousand letters and account breakdowns, with some accounts owing upwards of $6,000.
One patient gave a copy of their letter to the Yukon NDP. Health critic Kate White tabled it in the legislative assembly March 12 before questioning how long it would take for the government to intervene and “ensure that patient privacy is protected.”
“This issue has dragged on for much too long and patients are paying the price. It’s time for the government to step up and solve the conflict,” White said. “How much longer will Yukon patients have to pay the price for this government’s conflict with physicians?”
Health Minister Pauline Frost said that the Health Information Privacy and Management Act (HIPMA) lays out the rules for how health information can collected, used and disclosed.
“Any medical records held by the Department of Health and Social Services are kept secure at all times and there are internal policies to protect the safety of both paper and electronic records,” Frost said. “In closing, it’s mandatory that all health staff complete this privacy training and that we ensure confidentiality at all times.”
Heredia said that doctors received a booklet about HIPMA guidelines in late 2017, but it still “but that does not resolve the 15 years of questions of privacy and what they do with medical information once they receive it.”
However, he added that he remains hopeful that he’ll be able to reach some sort of resolution with the government before it’s too late.
“I’m hoping that this will be resolved and no one will be affected,” he said. “I’ve been affected enough, I don’t want to patients to be affected…. I’m still hopeful that we’ll be able to talk about this and we’ll be able to sit down and figure this out and that these doors won’t close, because they can.”
Contact Jackie Hong at firstname.lastname@example.org