TLC, Graft and Billable Hours

An old guy I know, who makes an art out of not sweating the small stuff, went for routine, periodic bloodwork that was prescribed by his cardiologist. When he phoned his doctor's office for results, a flat, grim voice told him that he must make an appointment because the physician needs to share the information in person.

When he asked whether there was something wrong, he was told that a face-to-face consultation was essential. 

He assumed it was bad news. He braced himself, clenched his teeth, crossed his fingers, did some deep breathing exercises, and took a chill pill.  Then he bundled himself up and waited for a bus on a frigid day. Not all the ice from a recent storm had melted yet.

When he got to the office, he was told "everything's fine."  He was immensely relieved and thanked the internist profusely.

I asked him later what the doctor charged. "I don't know and couldn't care less, because I never see a bill. Medicare takes care of it." 

The doctor could have saved him time and spared him anxiety and risk from the wind, frost and slipping on ice. But he held the patient's test results ransom so that he could bill for an office visit. That way he could cover himself legally. 

The medical coding system itemizes services and assigns them a number for insurance purposes.  Billing departments are experts at creative manipulations of sometimes vague terms, such as "consultation".  

For telling my friend he's okay, the doctor probably got reimbursed more than my friend's net weekly pay before his recent retirement.

Another friend of mine cut her hand on a sardine can. Fearing a permanent scar, she made the next available appointment, two months away, with a Manhattan hand specialist.  A few weeks later, I asked her about her hand. "Oh, I'm glad you reminded me. I totally forgot about it.  No scar and no pain. It's like it never happened. But since I made the appointment, I might as well keep it. I pay nothing out of my pocket."

Medicare and Medicaid are blessings.  People shouldn't spit at blessings.  Taxpayer funds are not infinitely renewable. 

Pain management is a legitimate field, rooted in science, that often is critical to recovery from illness and accidents. But some  providers regard the swindling of Medicare and Medicaid and also private insurance companies, as a victimless crime and are irresistibly tantalized by the absence of enforcement.

Does the tort system encourage shady referrals and  silent partnerships?

A "fender bender" happens.  No injuries.  Drivers sue and countersue. Get a neck brace so they look like Sir Walter Raleigh and remove it when nobody's around to realize it's strictly decorative. 

Claim whiplash and phantom back spasms and anything else that research done prior to complaint, says is resistant to MRI and CAT-scan detection. Maybe some range-of-motion loss.

Prop up the case to jack up the settlement to taste. Hire an attorney who gets a one-third cut.

The great majority of pain management clinicians are ethical, law-abiding, and competent, and are not guilty of falsification. But a few of them get away with exploiting Medicare and Medicaid on an industrial scale.

Vans packed with patients arrive at their treatment centers more frequently than buses at casinos.   What oversight is provided to verify that the claims of service rendered are accurate, not exaggerated, or even occurred at all? 

According to the American Academy of Professional Coders (AAPC), the largest such credentialing organization, " Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physicians' notes, laboratory and radiologic results, etc.

Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers."

There should be no fuzzy, gray areas.

Medical providers should be mandated to furnish patients with complete information regarding their submission of claims to government or private insurance. That should include the specific codes and corresponding descriptions. 

Willful, major and persistent errors should be punished not by a slap on the wrist, but a kick to the groin.

Movies, investigative reports and news stories have been generated, in some cases contrived, around the theme of corruption and waste , which ostensibly implicates certain industries, political payoffs, sweetheart deals, labor contracts and underworld racketeering. That's supposedly why it takes longer to repair a hundred-yard stretch of highway than it took to build the Empire State Building in 1931.  

Even in the absence of evidence, they tenaciously conjure an accepted entrenched culture of graft for extreme delays and cost overruns for infrastructure repairs.   But insurance company shenanigans, Medicare/Medicaid chicanery, and underground economy trickeries are forgiven.

Raiders of Medicare/Medicaid regard the national treasury as their private bank account. They don't feel like they're stealing, because no particular individual can be identified as being harmed by their incremental heists.  The wealth of the nation is personalized by all beneficiaries collectively.  

Law enforcement should vigorously prosecute looters.

Medicare/Medicaid are our friends. Private insurance companies are corporate hoodlums.

They are rapacious, single-minded predators lusting for profit with merciless indifference to the wrongful human suffering they cause. They are ruthless and pitiless. 

We play by the book, and they throw the book at us. They are bottom feeders for the bottom line.  

Where there have been hurricanes, earthquakes and tornadoes, their "adjusters" are as jackals foraging among the ruins of the human toll from natural disasters, looking for grounds to deny claims from loyal policyholders. 

They will find any pretext or escape route to evade and nullify contractual obligations. They will seize any spurious justification to hike rates or refuse payouts. 

If you had a perfect driving record and never made a claim in the 50 years since you got your license, and was never a day later submitting full payment, but one of your rear tail lights is dimming, your insurance premium will likely surge, because effective earlier this month, that violation is now punishable under the revised Department of Motor Vehicles (DMV) point system.  

Insurance companies are not at fault for the DMV's changes, but they will probably bump up your premium, because they embrace every rationale to do so. It defines their character as an industry.  So does their greed and miserliness in cases of wrongful death, when they coldly calculate the worth of human lives, based on income lost, owing to their being unable to labor while deceased.  

They are glad to do it. It saves them money, and they can argue they are simply following New York State law,  in which is codified the disparity in the relative worth of human lives based on their pay grades.  Bipartisan legislation that would corrected that, but equality under the law is apparently just a fatuous slogan, because Governor Kathy Hochul vetoed that bill.

New York remains one of the few states that appraises the payouts solely on the basis of projected lost income of the victim of wrongful death. Grief doesn't enter the picture for families of the deceased, no matter whether opulent or destitute.

It's getting harder and harder to navigate through a typical day of constant reminders about how dehumanized our society has become. Well-intentioned confidants and professional comforters coach us to just "go with the flow". 

Not so easy when you're caught in a riptide of the River Cesspool.