Tag Archives: insurance fraud

Health Care Reform for US – Why We Must Have It

I’m taking on one of the many, many myths about what will happen in the US if we have health care reform. Just one, but I think it’s one of the two or three most powerful and it says:

“If we change the system we’ll end up having to pay more.”

But how much do you know about how things work today?

Last month I had a sore throat. I went to my doctor. I paid my $25 co-pay. She swabbed my throat to check for strep, put the cotton swab into a little plastic dish, checked the reaction and said, nope, not strep. The sample did not go to a lab, no-one pored over it for hours analyzing it, and she told me that it often misses strep anyway, if it hasn’t developed sufficiently.

Three week later I got a notification that my insurance company was being billed over $70 for that test 1.

Luckily I have extremely generous health coverage courtesy of the Evil Big Pharma company that pays the bills around here.

But What If I Didn’t Have Good Coverage?

Back when I was first in the US, I went to a new doctor who recommended a series of tests “to establish a baseline” or something like that. I’m a good, obedient girl who assumed that doctors do what’s best for their patients, so I held out my arm and let him drain some of my blood.

Then my insurance company declined to cover the costs.

I freaked out and called the doctor’s office in a panic 2. They made sympathetic noises and sent me a revised bill for a token amount that was likely much closer to the true value of the doctor’s time and efforts. It was still an unwanted dent in the budget, but more than that, I was disturbed by the casual dishonesty of it.

If the test costs $30, why are you billing my insurance company $140?

As it turns out, this is standard practice.

The whole medical community (hospitals, specialists, general practitioners) understands that you have to get what you can out of the insurance companies when you can…and when you can’t, well, you still treat the patients who can’t afford you, using the cushion of money you built up by treating the ones who can.

You see what we’ve done here?

We’ve created a system where the only humane thing to do is commit insurance fraud.

Let’s be clear: I don’t mind subsidizing the less fortunate. I really, really don’t. I think it’s my duty and makes me more human, humane and decent. But I hate that it’s done dishonestly.

So what, if the insurance companies are getting scammed?

1, And I know I might sound hopelessly old-fashioned for saying this, but I believe this institutionalized fraud is bad for the soul, or, if you prefer, bad for the moral character of the people involved and the society as a whole. If you are training people to ignore the Jimminy Cricket voice that is chirping in their heads “You’re using someone else’s money to pay for this”, then you are training people to squash that voice in less altruistic moments too. Maybe I only use my cell phone for two business calls a month, but what the heck it’s easier just to claim the whole bill as a business expense on my taxes. It’s not that much money when you look at how much the government collects… Or, even worse: meh, everyone’s doing it.

2,  Less importantly but still significant: current practices drive up costs for everyone, making insurance more expensive for people who can afford it and inaccessible to people who don’t have a few hundred to spare for the premiums every month. Five years ago, my co-pay at the doctor’s office was $10. Last year it was $15. This year it’s $25. And my insurance company covers fewer services today than it did ten years ago.

And that’s without any reforms.

I can afford it now, but there was a time when that large a fee for every doctor’s visit (with a family of four it adds up) would have been a serious hardship.

If health care reform makes things ‘more expensive’, I say so what? It’s going to happen either way.

I’d rather it happen in a way that made health care more accessible to everyone.

I’d rather have less money to spend on plastic cr*p for my kids, and know that someone with a pre-existing condition who works two 30hr a week jobs 3 can actually go to their doctor when their condition flares up, and they won’t have to spend their off-hours researching the cheapest treatment options or the ways they can get into debt to cover the costs.

There’s a world of difference between ‘not being able to afford to go to Aspen twice this year because the government increased taxes on the fabulously wealthy to cover the health care costs of the stinkin’ poor4‘ and ‘not being able to sleep because I don’t know how I’m going to pay my child’s medical bills’.

Really.

  1. $70+ I kid you not. And it looked like one of those pee-on-a-stick pregnancy tests you can buy online for $1 a pop. I guarantee you my doctor did not pay even 50% of the bill for that test when she ordered them in bulk
  2. Being from the UK I wasn’t familiar with medical billing and the numbers boggled my mind
  3. because certain employers like to keep you below a certain number of hours so that they’re not legally obliged to pay health insurance benefits to you — ask me how I know…
  4. No-one except movie stars and sports gods will admit that they are wealthy, but I say if you’re earning over half a million a year, you’re wealthy. Get used to it!