HomeLatest ThreadsGreatest ThreadsForums & GroupsMy SubscriptionsMy Posts
DU Home » Latest Threads » Forums & Groups » Main » Editorials & Other Articles (Forum) » Where All Frauds Are Lega...

Sat Dec 7, 2019, 02:45 PM

Where All Frauds Are Legal."Welcome to the weird world of medical billing."NewYorkTimes:

https://www.nytimes.com/2019/12/07/opinion/sunday/medical-billing-fraud.html
______________________________________________________________________________________
By Elisabeth Rosenthal
Ms. Rosenthal, a journalist and physician, is a contributing opinion writer.
Dec. 7, 2019, 2:00 p.m. ET
_______________________________________________________________________________________

Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.

I have been circling around this conclusion for this past five years, as Iíve listened to patientsí stories while covering health care as a journalist and author. Now, after a summer of firsthand experience ó my husband was in a bike crash in July ó itís time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.

My husband, Andrej, flew over his bicycleís handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.

The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.

I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services.

What Iím talking about here were the bills for things that simply didnít happen, or only kind-of, sort-of happened, or were mislabeled as things they were not, or were so nebulously defined that I couldnít figure out what we might be paying for.

To be clear, many of the charges that I would call fraudulent ó maybe all of them ó are technically legal (thanks sometimes to lobbying by providers), but that doesnít make them right. And no one would accept them if they appeared on bills delivered by a contractor, or a lawyer or an auto mechanic. There were so many of these charges that I came up with categories to keep track of them:

(rest of story at link above..)

7 replies, 1435 views

Reply to this thread

Back to top Alert abuse

Always highlight: 10 newest replies | Replies posted after I mark a forum
Replies to this discussion thread
Arrow 7 replies Author Time Post
Reply Where All Frauds Are Legal."Welcome to the weird world of medical billing."NewYorkTimes: (Original post)
Stuart G Dec 7 OP
Midnight Writer Dec 7 #1
Skittles Dec 7 #3
Midnight Writer Dec 7 #4
Skittles Dec 7 #2
dalton99a Dec 7 #6
russ1943 Dec 7 #5
lanlady Dec 9 #7

Response to Stuart G (Original post)

Sat Dec 7, 2019, 02:58 PM

1. Was in the ER twice this week and admitted once. Waiting in dread for the bills.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Midnight Writer (Reply #1)

Sat Dec 7, 2019, 04:56 PM

3. oh dear

are you OK now, Midnight Writer?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Skittles (Reply #3)

Sat Dec 7, 2019, 05:54 PM

4. Yes, on the mend and doing well.. Now mostly worried about the bills.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Stuart G (Original post)

Sat Dec 7, 2019, 04:56 PM

2. it's crazy, it is legalized extortion

NO other industry could away with this crap.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Skittles (Reply #2)

Sat Dec 7, 2019, 10:34 PM

6. +1

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Stuart G (Original post)

Sat Dec 7, 2019, 08:50 PM

5. Medicare for all

From the perspective of the current issue regarding Medicare for all does this author and DUírs here see this medical billing problem as more or less likely under the MFA?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Stuart G (Original post)

Mon Dec 9, 2019, 08:10 PM

7. The scam is at all levels of the system!

My allergist/asthma doctor systematically bills my insurance company for breathing tests I didn't take. The basic charge for an office visit is $350 to take my blood pressure and get a five-minute consult with the doctor. My insurance pays $200 (outrageous enough) and I get stuck with $150 just to have the doctor do a quick check with a stethascope and write me a script for Prednisone. Nothing else.

Reply to this post

Back to top Alert abuse Link here Permalink

Reply to this thread