On my last trip back to Savannah, Billy and I met up with another friend and her family for dinner. They are the only Republicans I know who are actually for a nationalized American healthcare system. But I won’t even try to go into that debate in this entry… While she and her husband were questioning the logic of why it couldn’t be done in the United States when all other industrialized (or not so industrialized) countries have implemented it so successfully, they brought up the issue of health insurance frauds — not by consumers, but by the doctors!
So here’s the story as she explained it…
My friend’s insurance covers chiropractics for her back pain. So both her and her husband went to see a really good chiropractor in Savannah. But soon they figured out the guy was making appointments with them for unnecessary visits (it got pretty suspicious when the chiropractor called on Christmas eve to make an appointment for the next day). So it turned out that the chiropractor was trying to max out both of their insurance accounts allowable for each patient in that specific care coverage. He got so greedy that he even asked for their daughter’s insurance information!!
This is how the private insurance industry works in the United States as I understand it: For each covered plan, each person has a maximum allowable coverage for each type of care. For example, a particular plan may cover you for ER visits for up to $20,000 each year, after which amount you are liable to pay for the costs incurred yourself. Now just imagine a dollar value assigned to everything you’d ever need to visit a doctor for — flu shots, hospital overnight stays, surgeries, X-rays, MRI scans, medicine… etc. In other words, for an unethical doctor, he only sees each patient as a dollar sign walking in the front door of his clinic.
While the majority of doctors are probably good people, insurance frauds like what my friend’s family experienced happens often enough that now there’s a high premium offered by most health insurance companies. And now I understand those premiums are not necessarily incurred by unjust lawsuits from patients, high medical bills or even patient frauds. But most likely, it’s due to fradulent practices of unethical doctors. Just imagine how much money an insurance company could lose if one unethical doctor goes unnoticed/unpunished for 10 years with a solid patient base?
Health insurance fraud probably hapens quite frequently because in my friend’s case, they have gone through two chiropractors with exactly the same issue. And just recently, we also experienced the same thing ourselves when Grace visited our dentist.
As soon as the dentist found no cavities in Grace’s teeth, she had to come up with something to max out Grace’s insurance account. So she chose the most expensive procedure allowed under our plan, which was a deep cleaning. Granted a deep cleaning has long been overdue for Grace, but the amount to which the dentist charged the insurance company was suspicious enough to warrant a call from Grace to the insurance company. And Grace found out that the dentist was WAY overcharging Grace as well as the insurance company on the procedure (over $1500 total, $500 out of which is not covered by the insurance!). For $1500, a patient can have 4 deep cleanings done at other dental offices (as Grace confirmed by having called several dental offices to varify the prices).
It’s pretty disgusting to get the feeling that your doctor doesn’t see you as a patient but more like a walking dollar sign. If insurance companies have to keep charging customers for higher premiums to cover their losses to the doctors, ultimately United States will have one of the least insured population eligible for healthcare. And that’d be a pretty sick population.
