Having been the kings of flim-flam for decades now, we should have figured that private insurers would immediately figure out ways to keep their scams going even after the healthcare reform law went into effect.

And surprise, surprise… they did, and they will.

The profit motive is great for getting the best pair of jeans. It is absolute shit for getting the best healthcare delivery. Private insurers cannot make a massive profit without scamming policyholders, up to and including KILLING them to avoid paying any claims. Thus it has been, thus it is, and thus it will always be. In this greed-driven Uhmuhricuh we’re living in, private health insurance is a lethal mistake that must be corrected at the earliest opportunity. But the insurers aren’t the only ones who need to be corralled; even at supposed “non profit” providers, CEOS are raking in millions of dollars a year.

However…. this is about the insurers, so we’ll stick to criticizing them today.

 

Bill Dunphy thought his colonoscopy would be free.

His insurance company told him it would be covered 100 percent, with no copayment from him and no charge against his deductible. The nation’s 1-year-old health law requires most insurance plans to cover all costs for preventive care including colon cancer screening. So Dunphy had the procedure in April.

Then the bill arrived: $1,100.

Dunphy, a 61-year-old Phoenix small business owner, angrily paid it out of his own pocket because of what some prevention advocates call a loophole. His doctor removed two noncancerous polyps during the colonoscopy. So while Dunphy was sedated, his preventive screening turned into a diagnostic procedure. That allowed his insurance company to bill him.

Like many Americans, Dunphy has a high-deductible insurance plan. He hadn’t spent his deductible yet. So, on top of his $400 monthly premium, he had to pay the bill.

“That’s bait and switch,” Dunphy said. “If it isn’t fraud, it’s immoral.”

President Barack Obama’s health overhaul encourages prevention by requiring most insurance plans to pay for preventive care. On the plus side, more than 22 million Medicare patients and many more Americans with private insurance have received one or more free covered preventive services this year. From cancer screenings to flu shots, many services no longer cost patients money.

But there are confusing exceptions. As Dunphy found out, colonoscopies can go from free to pricey while the patient is under anesthesia.

Breast cancer screenings can cause confusion too. In Florida, Tampa Bay-area small business owner Dawn Thomas, 50, went for a screening mammogram. But she was told by hospital staff that her mammogram would be a diagnostic test — not preventive screening — because a previous mammogram had found something suspicious. (It turned out to be nothing.)

Knowing that would cost her $700, and knowing her doctor had ordered a screening mammogram, Thomas stood her ground.

“Either I get a screening today or I’m putting my clothes back on and I’m leaving,” she remembers telling the hospital staff. It worked. Her mammogram was counted as preventive and she got it for free.

“A lot of women … are getting labeled with that diagnostic code and having to pay year after year for that,” Thomas said. “It’s a loophole so insurance companies don’t have to pay for it.”

For parents with several children, costs can pile up with unexpected copays for kids needing shots. Even when copays are inexpensive, they can blemish a patient-doctor relationship. Robin Brassner of Jersey City, N.J., expected her doctor visit to be free. All she wanted was a flu shot. But the doctor charged her a $20 copay.

“He said no one really comes in for just a flu shot. They inevitably mention another ailment, so he charges,” Brassner said. As a new patient, she didn’t want to start the relationship by complaining, but she left feeling irritated. “Next time, I’ll be a little more assertive about it,” she said.

 

I can hardly wait to see the new and improved loopholes still to be discovered. I’d imagine there will be a killing-actually, a few of them-in the private insurance arena even after the 2014 reforms all kick in.

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