Where is the Mafia now?

Sometimes watching an old documentary or investigative report on TV about the mobster days makes me wonder, “what ever happened to organized crime?”  I can tell you this, it seems very clear that the extortion rings from bygone days are alive and well in the health insurance industry.  At the very least it is incredibly clever of the 1% in how they are able to manipulate “their” system (it is in no way a system that benefits the masses and as such cannot be called “our” system) to harvest the maximum profits for themselves. Keeping the minions running on the treadmill is certainly clever but even more so in that they are able to legislate many of the tactics employed – making it legalized extortion. Even those tactics that are not legislated are in many cases unenforceable either because it is virtually impossible to litigate against the corporate behemoths or there is no desire from enforcement agencies in any real way to police the industry’s infractions.

Because they [the "health insurance industry"] help some individuals they are able or at least willing to use that as a justification for continuing what I would term “legalized extortion” in providing what they ask us to call – healthcare. (it is like saying someone that does very bad things isn’t really bad because they are loving to their own family or occasionally do something nice so as to use that as a rationalization for all the bad things they do) They are able to sustain and increase their control over this system by manipulating the legislative process through among other things, their incredibly powerful lobbying of the U.S. Congress. 

The Rat Race

An example of how those in power make it more and more difficult to manage records and accounting for their actions with sometimes seemingly small or simple things - like changing the Provider information on the Explanation of Benefits statement that result from the filing of claims. My “EOB” used to contain the healthcare providers business name whether or not they were “in” or “out” of network.  Recently if the provider is not in my plan’s network of providers (in network providers seem to be becoming more and more scarce for the most obvious of reasons – they are squeezed in the same way that the insured are) then the providers name is omitted from the EOB. This certainly makes it more difficult and far more time consuming for the insured, especially if the insured suffers from a chronic medical condition and is more often having to check records to verify claims.  Why? Well the more cumbersome it is to deal with insurance claims, tracking and verifying that the claim was filed, filed using the proper medical coding, determining if the payment is correct and that the deductible was applied the more likely it is for the insured to just give up and/or accept all the gobbly-goop, tons of paperwork (or electronic paper) that is heaved upon one.  This in addition to making sure the provider is charging correctly and for the most part accepting the “allowed” amounts which the industry determines is usual and customary. For example, the hospitals (two different ones) that we used when delivering our two kids both double charged us three and a half years apart and in one case the double billing invoice was sent to us 18 months after the delivery! Coincidence, very remote maybe but I’ve talked to other parents who have experienced the same thing and yet others that were over charged or double charged for surgical and other health provider services. 

These are among the things that make it difficult if not near impossible to follow and understand our health care costs. More and more it seems that payment of often times bogus charges, mistakes that generate additional profit and just plain phony or jacked up charges on bills for healthcare services are what we are faced with when we are ill and in need of care.