In addition to examining and treating patients, doctors are responsible for an inordinately long list of administrative duties which they are forced to do out of the goodness of their heart. Some of those tasks, like billing, coding, and prior authorizations, I have written about previously.
Other such duties include Medicaid Work Exemptions, authorization of the use of Emotional Service Animals, verification of disability to justify issuing a permit to use Disabled Parking Spaces, and the granddaddy of them all, the Family and Medical Leave Act. Each of these items requires either the doctor himself or herself, or a specially trained employee, to research the patients record, reach a decision on the person’s eligibility, and then produce a document, or complete a form, that proves the individual meets eligibility requirements.
The “One Big Beautiful Bill” passed last year, required “able-bodied Medicaid recipients aged 19-64 years, covered through the Affordable Care Act Medicaid expansion…to work or do volunteer service for at least 80 hours a month to maintain Medicaid eligibility.” To waive this requirement, you must be disabled, or be in poor health, and obtain a medical exemption. To apply for that exemption, patients may ask their doctor to verify their diagnosis, symptoms, medications, and their status regarding functional limitations. Doctors must provide Medicaid with a report confirming the patient’s inability to work the minimum required. Doctors do this for the patient under the threat of committing Medicaid fraud, being heavily fined, losing his license, or being jailed if the CMS, Centers for Medicare and Medicaid services, finds the report inaccurate. The doctor must also provide periodic updates on the patient’s continued eligibility.
Emotional Support Animals, ESA, is another area where doctors are obligated to verify their necessity. The Americans With Disabilities Act (ADA) defines a “service animal” as one trained to perform a specific action to help a person with a disability to perform specific tasks of life. An Emotional Support animal is “a pet that provides companionship and eases symptoms of mental and emotional disability.” The ADA protects service animals but not ESA’s. Doctors are occasionally asked to write a letter to justify ADA protection for an ESA. It must contain specific information about the individual’s disability and how it interferes with their daily activities. This letter is also subject to loss of license and jail time if it’s deemed to be fraudulent.
Disabled Parking Permits are a common request from patients. There is a far greater number of handicap permits issued than there are handicap parking spaces. Doctors must fill out a form that explains the reason for issuing a handicap parking permit. It behoves the doctor to assess the real need because some cases are ambiguous and open to criticism. Observers may find people appear healthy when they have a symptomatic cardiovascular disorder that only the patient is aware of. Doctors completing the authorization form are subject to a $10,000.00 fine and 18 months in jail if deemed to be fraudulent.
Last, but far from least, is the mother lode of all forms and entitlements, the Family and Medical Leave Act, or FMLA. In Indiana, the form used to apply for this benefit was so complicated and ambiguous that I never filled one out correctly the first time. To fill it out accurately I always had to call the patient and get the specific detail of the situation. This federal law allows eligible employees “up to 12 weeks of leave in a 12-month period” without the threat of losing their job or health benefits.
This was allowed for one of the following reasons:
The birth of a child and to care for a newborn child within one year of birth.
The placement of an adoptive or foster child within one year the employee.
Care of the newly placed child.
To care for the employee’s spouse, child, or parent, who has a serious health condition.
A serious health condition that makes the employee unable to perform the functions of their
job?
Any qualifying predicament arising from the employee’s spouse, son, daughter, or
parent who is on active duty with the US Military.
The FMLA certification form has a long list of items it must include to give the evaluator enough information to authorize leave. Filling out this form could easily take 30 minutes because of the ambiguity of the questions. And like I said, I never filled one out correctly the first time.
All of above mentioned items fall into the category of uncompensated care. To comply with agency requests for Medicaid Work Exemptions, Emotional Support Animals, Disabled Parking Permits, and Family and Medical Leave Act, it was necessary to review the patient’s record, reach a decision on eligibility, and spend time preparing a letter or completing a complicated form for which no compensation was received. I did it as a favor to my patient. The big rub occurred when I did not feel the person was justified in receiving the benefit they sought. Saying “no” was not taken well by the patient. Denial never reached the point of being sued, but it did anger the patient enough to dismiss me as their doctor.
I remember a patient who asked me to write a letter he could send to his insurance company justifying writing off the cost of his new swimming pool because he used it as a therapy pool for his osteoarthritis. I had a problem agreeing with him and refused to write the letter much to his chagrin. He didn’t fire me, but he was not happy.
As you can see, a family doctor performs a lot of duties no one is aware of. It’s not only one patient after another, but also administrative tasks one after another done pro bono. I had to call it customer service to justify the work for which only attorneys are compensated.
References: Lane L. Patient Requests that can put you in a tough position: Medicaid Work Exemption, Service Animals, and More medscape.com 2026 June 15.
U.S. Dept of Labor. Family and Medical Leave Act.
