In this interview on Fox Business’s Coast to Coast, cardiologist Dr. Tiffany Di Pietro explains how the Affordable Care Act has dramatically increased patient deductibles and out‑of‑pocket costs, leading to a loss of patients and financial strain on her private practice. She notes that deductibles that were once a few hundred dollars are now commonly $5,000–$10,000, forcing patients to either pay large sums up front or forgo essential cardiac testing. Dr. Di Pietro describes typical cardiac work‑ups—echocardiograms, stress tests, and nuclear stress tests—costing $600 to $1,200 after deductibles, and recounts how many patients either decline the tests or request cash payments, which can sometimes be cheaper than using insurance. She also details the cumbersome insurance authorization process for advanced imaging, requiring “25 hoops of fire” before a nuclear stress test is approved. The combined effect is that patients disappear from her practice, she sometimes provides care without charge to ensure necessary diagnostics, and the practice bears the cost of technicians, highlighting the broader negative consequences of Obamacare on private cardiology services.
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Tiffany Di Pietro, says Obamacare has had a negative impact on her patients. And the good doctor is a cardiologist, so she's a real schmotty pants besides. So, Doctor, what are you seeing up front?
It's been a little bit of a problem in my practice, honestly, really because of what the gentleman was saying. People's deductibles and their out-of-pocket costs are through the roof. And the problem is, is most private practitioners like myself We collect this money up front. We don't send them bills. So when we tell someone that their annual physical or their follow-up visit is going to be over $100, they look at you like you're crazy because, "I have insurance. Why am I having to pay so much?" That's one problem.
The second problem is that— Is that an Obamacare phenomenon or did you have this prior?
No, the deductible in my practice at least has been an Obamacare issue. The deductibles of $5,000, $10,000 were just not there a few years ago. Now, some plans, of course, they were, but as a whole, if we're looking at insurance as a whole, the deductibles have ballooned big time. Um, go ahead. The second problem really is, is this, you know, the biggest lie of 2013: you can keep your health insurance and you can keep your doctor, but I couldn't keep my patients. It's like a bad rerun of Jerry Maguire— where are my patients? My patients have disappeared from me because they can't either afford their plan or I can't get on their plan as a practitioner of whatever insurance plan they have.
Now obviously things get very expensive when someone has a cardio-related issue, and then with those high deductibles, all bets are off, right?
Of course, yeah. I mean, you know, when someone comes to see me and they're having chest pain, odds are they're gonna need an echocardiogram, a stress test at a minimum, and the office visit. I mean, the out-of-pocket through an insurance, if I bill that and they have a deductible, you're looking at close to probably $600. And a lot of times patients say, well, I don't even want to go through my insurance, I just want to pay you cash, will it be cheaper? And honestly, a lot of times it is cheaper if they don't go through their insurance.
And a lot of them will risk not getting that checkup or that cardiogram or what have you because of the cost involved and endanger their lives, right?
And that's true, and it is their right. It's their right to say, "Well, I can't afford that," or "I don't want that." And then it's my responsibility as a practitioner to try to, you know, nudge them in the right direction. And a lot of times I've just done it and not charged them because I really know it's something that they need. Then affected my practice because I have to pay the technician who's doing the study.
Do they go outside your practice to get those, or do you have a lot of these, either MRIs or scans or, you know, electrocardiogram machines available to your office, or they have to go out of your office to get it?
I do a lot in my office. I do plain stress tests and echos in my office. But when we're talking about someone, for instance, who needs a nuclear stress test, first of all, I have to jump through 25 hoops of fire and a leotard to try and get them approved by these insurances. And then once they are approved and they have to go towards a deductible, you're looking at upwards of $1,200 for nuclear stress tests. It's unbelievable.
Wow, that is bizarre. Uh, Doctor, thank you very, very much. We'll watch what happens. I'd love to have you back. Uh, Dr. Tiffany Di Pietro, that's the reality, folks, here, because a lot of the times the things that you would need to check up and see if you need something more severe, if it's expensive, you're just not going to do it. And in extreme cases, you're going to die. A little more after this.
