February 21, 1997

Medical Insurance

Insurance, n. An ingenious modern game of chance in which the player is permitted to enjoy the comfortable conviction that he is beating the man who keeps the table.

Ambrose Bierce, 1911

About 10 years ago, when I took my mother to the doctor; after all of the medical business was over, the doctor's assistant gave my mother a Medicare form to sign, told her what the amount was, and she wrote a check for 20% of the amount. It was simple and straight forward. Medicare(Part B) paid 80% and the patient paid 20%. Her doctor had agreed to accept the amount that Medicare would pay for the service rendered. It is called "accepting assignment." If the doctor wanted more money, the patient had a choice of paying it or finding another doctor. Most doctors went along with Medicare because what Medicare agreed to pay was usually fairly generous.

When a person has more than one organization to pay medical bills, it gets much more complicated -a regular can of wiggly worms. For example; when I had some surgery, I found out that Blue Cross-Blue Shield had paid for it all. Medicare paid none of it. I had been paying into what is called "Medicare part B" for nothing. The money that I paid in for absolutely nothing was gone and I would never see it again. If it wasn't for the fact that the money came out of my Social Security check, I would have been outraged. I suppose that a person doesn't miss money that he never sees.

The army had a word that describes the state of medical financing: FUBAR (F_ _ _ ed Up Beyond All Recognition). This was one reason that I wanted to see a national health insurance plan. Those of us who wanted this were opposed by the insurance companies and HMOs who are making mega-bucks doing what they are doing. They also put some of those big bucks into the campaign coffers of the president and others. This meant that the president and his wife listened to them, and not to me -I only had one small vote.

I am as far away from being an expert on health insurance payments as it is possible to get. I did learn one new word: "provider." A provider is someone who provides something to the patient that an insurance company may have to pay for. This can be a physician, chiropractor, physiotherapist, hospital, nursing home, nurse, ambulance company etc.

The attitudes of provider about payments can be very varied; ranging from some who will write a charge off if you don't pay in a week or two, to some who will send a collection agency after you if you are two days late in paying a $5 charge. Some will threaten to ruin your credit rating, and some will offer you a discount for prompt payment -sometimes for charges that you really don't have to pay. If someone threatens to send a collection agent after me, that is the last of my business that they will ever see. The people who are most vulnerable to these hucksters are the old. Many have been taught that they are supposed to pay their bills when they are received. They are often conned into paying money that they really don't owe. Outright fraud in medical billing is so common that no one is even attempting to deal with it. Many a hospital patient who is on intravenous feeding is billed for daily bedpans despite the fact that he hasn't defecated during his whole hospital stay. It is assumed that these practices are just sloppy bookkeeping rather than outright fraud. I doubt it.

I have one bit of advice for those of you who are considering writing a check to a provider: Don't write that check unless you are absolutely, positively, 100% certain, that you owe them that money; because if you do send them that check and you don't owe it, you have kissed that money goodbye forever. And don't be intimidated by any threats because the swine who threaten you don't deserve the money even if they did earn it.

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