A key feature of our market-based healthcare system is that it provides little incentive for insurance companies to straighten out billing issues if the correct result requires the insurance company to write a check.
My shocking discovery today: not only is there a sort of fraud where people round up perfectly healthy people and persuade them to have unnecessary and dangerous surgery and claim it off their insurance for the benefit of the doctor performing the surgery, but this fraud is so common that there is a slang term ("cappers") for the patient-rounder-uppers.
In my own unicorn universe, I sometimes envision the Supreme Court tossing ACA out on the grounds that the individual mandate is unconstitutional, prompting Congress to go all in for single-payer. I realize this scenario is so far-fetched as to be make believe, however.
See also: IKEA employee enters great long string of product numbers into LoB app, which prints out even longer packing list. Delivery employee retypes details from sheet of paper into what turns out to be a MS Excel/VBScript pseudo application. And then into another to check stock availability. hea.dde.sk
hea.dde.sk
Be careful. That desk is made of MDF sawdust and glue.
The point is the 'fuck you'.
Mouseover!
Annoyingly, there are only three google hits for the exact phrase "cost reduction by inconvenience." One is to a comment I made in this very forum, and the other two are online notes based on the medical ethics textbook I and many other philosophers use.
This idea deserves to be more broadly known and understood. They are doing this on purpose to discourage you from actually seeking healthcare.
8: Wouldn't that be a subset of price-discrimination by inconvenience, if you were looking for more writing about it?
8: do you have evidence of that, rob? Or are you just assuming it must be true because it makes so much sense? I'm not challenging you, by the way; I really would like to see such evidence.
My only source is the medical ethics textbook I teach from, the one that is also the source for the other two google hits for the phrase. The text is Munson, Intervention and Reflection.
I'll look up price-discrimination by inconvenience. I need to research this all for next summers bioethics class anyway.
They are doing this on purpose to discourage you from actually seeking healthcare.
That, and presumably the longer they hold out the fewer actual bills they have to pay and, I'm guessing, they make use of the interest free loan.
2 needs a link. What sort of surgeries are we talking about?
Perhaps I'll be hated for saying this, but my decision to move to Europe post college and continually find reasons to stay longer (8 years running now, with at least 3 more guaranteed) keeps paying dividends. At this point I'm thinking I can't move back to the US even if I wanted to, since I didn't spent my 20s developing the necessary survival skills.
my decision to move to Europe post college and continually find reasons to stay longer (8 years running now, with at least 3 more guaranteed) keeps paying dividends
Are you ready for the barter economy in Europe when there's no more money?
13. The answer is in 6 - double hip replacements.
15: I move to Germany in a few days, and I'm just trying to get all my euros into a bank account there as quickly as I can, so if there's a breakup, at least I'll have the best piece of the fractured currency.
16: If you're actually worried about it, I suggest you look at the country just to the south of Germany, the one whose economy is built on piles of Nazi gold.
17. The one containing Schloss Habsburg, or the one that provided the power base for the eponymous family?
"cost reduction by inconvenience."
Don't manufacturer's rebates fit closely, too?
No, our computer does not store information of denied benefits if we can't identify the patient.
Wow. Seriously? I suppose if they say so, then it's true (ahem), but honestly this is utter bullshit. Is there a claim number on the Explanation of Benefits form? Things should be stored by claim number. I really can't imagine not keeping a record of any claim you've processed, whether you denied benefits or not.
Report 'em to the state's health insurance oversight bureau!
Re: "cost reduction by inconvenience" in rob's comment 8, it's long been my understanding that this is standard procedure for health insurance companies, but I have no proof, and the companies' employees ain't talking.
"Rationing by inconvenience" gets 4000 hits.
Does everyone else get an "explanation of benefits" mailed out every time you have an office visit? Now that I'm going to the alienist, I'm getting at least 1 a week, often more. I don't know if there's an email option, you would think that would be efficient and sensible, but it's insurance companies we're talking about here, so who knows?
The more sensible companies will send just one EOB for maybe a month's worth of visits to the same provider. But yeah, the amount of nearly useless paper that insurance companies send you in the mail is really annoying.
EOBs aren't useless pieces of paper. You wouldn't want to rely on their electronic records, would you?
I've actually had many an occasion over time to send a copy of an EOB to someone -- say, the original health care provider (who should have gotten one themselves, but never mind that) -- in order to show what appears to have gone wrong in the billing.
We've talked about EOBs before here, and apparently not a few people don't receive them from their health insurance companies, no. I was always instructed never to pay a provider's bill until I'd received a corroborating EOB from the health insurance company, and sort of can't understand why you'd just pay what the provider says you owe without that corroborating information. But I can be pretty damn stubborn about things like that, and don't mean to sound like a scold.
24: Well, sure, if there was something I was unsure about, then yeah, I'd want the EOB. But this is just standard $11 copays.
25: Right, but suppose the provider suddenly sent a bill for $100. You'd want the EOB to explain to you why it wasn't just the $11 co-pay. It doesn't sound like seeking an explanation after the fact is always going to work out very well: "we don't keep records for denied benefits." (??!)
I tend to trust my insurance company to keep relevant records more than I would Heebie's, but generally I'd rather have the piece of paper that confirms things, even if I do just stick it away in a pile most of the time.
Wow. Seriously? I suppose if they say so, then it's true (ahem), but honestly this is utter bullshit. Is there a claim number on the Explanation of Benefits form?
I assume that I'm talking to some poor sap who has just been coached on what to say, and is probably kept in ignorance of where to find any information that they're not supposed to hand out.
Also, all I got was a bill from the lab explaining how much I owed, and saying that insurance had denied covering the charge. I didn't get anything from the insurance company, because that would cast their pitiful computers into suspicion.
European healthcare bureacracy is not ideal either. When Sandra was earlier this year she got homecare for a couple of hours a week to help her take her medicine plus get her to drink enough etc, which is paid for by the city council through a national scheme, with private contractors to do the actual work. Some are awful, some are so-so, the one we got was brilliant. It's all free at the point of care but depending on your income and whatnot you have to pay some contribution to the costs of your care, which is administered by a central bureaucracy.
Which doesn't work very well. They bill you per four week period, but tend to bunch them up at the end of the year so you end up paying, like I just did, some 1200 euros or so for care gotten in February to August. And then Sandra gets 500 euros of that back as well, for having been chronically ill, which is paid out a month later. Would've been easier if they'd just substracted this in the first place, but never mind.
Not that I couldn't afford it and these were the largest health care costs we had to pay for her, but it doesn't help so close to the holidays...
28: I was so sorry to read about Sandra. How are you doing?
Martin, I didn't know anything about Sandra -- hope she's recovering well enough.
The paper wastage that's bothering me recently about the stacks of EOBs I get are the notices that come with every single one about availability of translation of important notices to different languages. It's not that there's anything wrong with the service, but it does seem like overkill to have a full-page insert about it in every single mailing.
27: Also, all I got was a bill from the lab explaining how much I owed, and saying that insurance had denied covering the charge. I didn't get anything from the insurance company, because that would cast their pitiful computers into suspicion.
As I've said, I wouldn't be accepting of any insurance company that didn't provide an EOB for claims. Providers are all over the board in how they break out and explain any payment they've received from insurance. It's to our benefit to understand how it's all been rendered, and the insurance company is the outfit to provide that information, which they should do as a matter of course. If not in print, at least via email notification (with, like, a link to a downloadable PDF), if they want to make that an opt-in.
Not to be shrill or anything, but really. Not providing an EOB is bullshit.
I think in this particular situation they're denying having ever heard of the patient (because of the name misspelling). To send out an EOB to Hokey Pokey c/o Heebie Geebie, they'd have to admit they knew who he was, which would contradict the rationale for refusing to pay the claim.
17: I'm not actually worried about it. I'm in the "They'll do what they need to do, at the end of the day" camp.
33: They'd have to admit they received the claim at all (attached to Heebie's member ID and group number) and they're inexplicably refusing to do so.
Their story is that they don't keep records of claims if they can't identify the patient. You're right that this is absurd, but that's the whole point of the post, that it's absurd. The absurdity isn't in the refusal to provide an EOB, though, it's in the refusal to admit that given the insurance information that was almost certainly provided to them, they actually could have identified the patient.
36: We'll have to disagree, on however minor a distinction: it's not that they could have managed to identify the patient, it's that they can't provide a statement (EOB, record) of having received the claim at all. I can see why they'd want to straighten out the patient's name.
For all we know, insurance companies receive bogus claims like this all the time, attached to a legitimate member ID and group number. If so, one would like to know about whether John Doe, Jane Deer, and Hokey Pooky are placing claims, since it is one's own member ID and group number, after all. It's the failure of record keeping that's idiotic.
30: Sadly, no: she died three weeks ago.
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My boss just said that his grandmother used to say "you'll do wonders and shit cucumbers". That is officially my new favorite phrase, even though I have no idea what it means. Google has about 300 results for it, so it's not completely unknown, but pretty rare. Any other goodies people know?
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38 -- I didn't know either and am so sorry to hear that. Stay well.
It's (at a minimum) constructive fraud, is what it is, and I wish we had regulatory agencies and a judiciary that were willing to treat it that way. People are promised benefits (whether (big deal) medical insurance coverage or (smaller deal) a $30 mail-in rebate on their new stereo system) and the company sets up procedures (whether intentionally or negligently) that are so inconvenient as to predictably ensure that some significant percentage of people won't recieve the benefit they were promised.
When you can prove that the effort is intentional (which would bet is more often than you might think, if you got access to internal corporate documents), it should be treated as outright fraud and criminally prosecuted. When it seems only to be the result of corporate neglience, it should be treated as (constructive) fraud for civil purposes.
38: Martin, I am so very sorry. All good thoughts headed your way.
I wouldn't be accepting of any insurance company that didn't provide an EOB for claims. Providers are all over the board in how they break out and explain any payment they've received from insurance.
What does "wouldn't be accepting" mean in this context? Most people don't have a choice of insurance providers. Mine provides terrible EOBs that never line up with statements from providers, which means that for basically every single bill I have to figure out some way to reconcile the differences or get into the middle of a fight between the insurance company and the provider (which in every case so far has ended up uncovering error on the part of the insurance company), which is inevitably a giant headache and huge waste of my time. But it's not as if I can change insurance companies. So, again, I'm not sure I understand your statement.
I mean that I'd be pretty demanding of an insurance company that didn't provide an EOB at all. I'd insist on making my way up the chain of supervisors on the phone to demand to know why I wasn't being provided with an EOB for each claim.
Whether the EOB matches the provider's bill is a separate matter, and is where most headaches come in, but without even an EOB, you can't even get started on that.
I do generally get EOB statements from them, for the record.
18: The one containing Schloss Habsburg, and conveniently in possession of its own, non-Euro, currency. The other one is probably fucked in the short run.
34: I think that half the time. The other half the time newspapers quote European policy-makers that sound so out of touch with reality that I think they're going to fuck it up.
38: My condolences. When people you care about die they leave such a big and deep hole in life it's amazing anyone gets through it.
38: I'm so sorry to hear that, Martin.
22: I receive my EOBs electronically. It's no great convenience. It takes longer to open a link, type in a password, find the new document, and load a PDF than it would to tear open an envelope. But, you know, trees.
I know trees, but not in the carnal sense.
38: I'm so sorry for your loss. You're writing about it in a way that makes it so relatable, for lack of a better word, but that just highlights how awful the situation is for you.
52, others: thanks. It is rough atm, but for better or worse it didn't come as a surprise; she'd been in and out of hospital for two years and had had her treatment stopped about a month and a half before she died, so I had some time to make my peace with her decision. It was harder on her sons (both adult) who live in England and had less day to day experience with her illnesses, so it all came as somewhat of a surprise to them.
And luckily I have a very supporting family, which helped a lot.