Tardiness or refusal to pay what doctors consider legitimate medical claims may add as much as 15 to 20 percent in overhead costs for physicians, forcing them to pursue those claims or pass along the costs to other patients, according to Jack Lewin, a family doctor who is chief executive of the California Medical Association, a professional group of 35,000 physicians.Don't say I didn't tell you so. The game in this is obvious, of course: the longer they delay payment, the longer they hold onto your money (that is, those mountains of premiums you pay every month), which they're all the while using to make more money, just not for you. In this way have they scored even if they do end up paying the claim. To quote the Times's judicious phrasing:
How is it, as the nation staggers under growing health care costs, that the commercial insurers responsible for paying much of the bill tend to be highly profitable and have stocks that are performing well? Tight-fisted approaches to paying bills may be part of the answer."May" indeed. Meanwhile, they've added administrative costs to everyone down the line, not least to the actual physicians who deliver your health care — but also, just in case you care, to you and to your employer, assuming you have one, and assuming the one you have subsidizes your insurance.
I believe the official term for this is waste.
As a rational, free-enterprise- and market-loving American, you're supposed to hate waste. But of course that's only the textbook answer. Off the pages and in the real world, waste can be a business's best friend — as long as it's someone else's waste.
Especially when it allows you to come back next year and talk about the rising costs of health care, especially doctor visits — seeing the circle yet? — which rising costs of course dictate a corresponding rise in premiums. After all, they're running a business here, not a ... well, just not something else.
Thus are you subsidizing, one way and another, the profits of a long list of corporate giants. Thus are you purchasing their executives not just food and wine, but trips to St Bart's, new wings on the McMansion, an extension to the backyard pool, and membership to that country club with the killer back nine.
Class warfare? You bet. But who started it? And who's got all the ammo? And who, in fact, can be said to be winning?
Think of it this way, because this is the way it is: it's in their interests to delay payment of claims. It's in their interests to deny claims. It's in their interests not to do the very thing you believe they exist to do, which is take care of your health care bills. Leaving aside the moral dubiousness of such a strategy — of making profit, that is, from others' illnesses and misfortunes — it's a sorry-ass way to see that anything gets done. Particularly when that "anything" is keeping people healthy, or making them well once they're sick.
It is, on the other hand, a great business model: take lots of money in, let as little as legally possible out. And let's remember that "legally possible" can take ten or fifteen years to define — or it can, at least, when you've got the best lawyers a fat stack of unpaid medical bills can buy.