Health Insurance, Medical Expenses, and Unscrupulous Doctors

The other day, David at My Two Dollars lamented how he’s falling further into debt due to his medical bills. The gauntlet of procedures he’s going through just reminded me of my own situation. In fact, we just received my wife’s first hospital bill — $1,510 for her epidural! Thank God our insurance covered most of it and we only have to pay about $250.

Based on my experience, there are a lot of unscrupulous doctors out there; and unfortunately, I am a magnet for bad ones. For instance:

Doctors that recommend more visits than needed. I had a doctor who wants me to visit him monthly. I am a healthy 30 something person, and in my book twice a year is more than enough. Worse yet, he wouldn’t share any lab result and I have to go in for a visit in order for him to tell me everything was fine.
Doctors that recommend unnecessary procedures. After I left that doctor, I ran into another one that recommended all kinds of procedures. Come to think of it, the previous one also recommended a lot of procedures. What’s up with these doctors?
Doctors that falsify insurance claim. This most recent doctor that recommended a lot of procedure also falsify insurance claim to get more money from the insurance company and me. Even when I told his secretary that 11 Echocardiograms on the same day was definitely a mistake, she refused to correct the claim and won’t return my phone calls. I am still unable to resolve this dispute, and I refuse to pay that doctor another dime until he corrects the mistake. Unfortunately, my insurance company wasn’t very helpful either.

To be fair, there are also a lot of great doctors out there — e.g., my wife’s OB/GYN that took care of her during her pregnancy, our pediatrician, and our dentist. Expensive health care is a huge problem in the United States that is worsens by unscrupulous health care providers, uninformed patients, and the norm of our society — e.g., over consumption, lack of exercise, etc. Recently, I am doing my part in alleviating this problem by questioning everything that the doctors recommend — e.g., is it necessary, what if I don’t do it, etc. Now, I just have to get off my behind and exercise.

14 Comments

AlB
February 14, 2008, 7:42

You have seen just the tip of the iceberg. I managed employee benefits for a 500 employee company for a number of years. Just a few points to add:
Does the doctor have an equity position in the lab providing those tests?
The insurer, in many cases is paid based on claims volume ($). Why should they question the claims?
The biggest ripoff is prescription drugs – Employers pay insurers based on AWP – that is meant to mean Average Wholesale Price but really means Ain’t What’s Paid
Consultants run seminars on code gaming – how to maximize revenue for doctors by optimizing procedure code groupings.
And it goes on and on
rocketc
February 14, 2008, 8:21

All i can add is, my wife did not use an epidural for any of our three kids. She is a gem.
I think we will quit having kids while we are ahead.
Adfecto
February 14, 2008, 9:37

I’ve written on this topic too. Medical expenses drive me NUTS! My dentist is the most guilty party for me. The problem is that there is only one in-network provider for my dental insurance with a 50 mile radius. They are so bad that for regular cleanings I go to the dentist I like and pay cash ($55 per visit) rather than deal with the terrible customer service and billing mistakes at the in-network doc. When I have major work done however I can’t afford to skip out on the insurance. I hate the system.
FourPillars
February 14, 2008, 9:41

Expensive stuff – when my son was born, my wife was in the hospital three days, epidural, c-section and all I had to pay for was parking (which I thought was excessive).
Mike
David
February 14, 2008, 10:10

It’s a sad state of affairs here in America. We all need to be more careful, thanks for the mention Pinyo.
Jeff
February 14, 2008, 10:47

Pinyo.. I share your frustrations with the American medical system, however until a doctor is paid to keep me healthy and stops getting money when I get sick the system isn’t going to change. And when you think of it why should it? Add to the messed up incentive system all the loop holes behind the scenes and we have one very abused system.
FourPillars.. actually you did pay for the hospital, etc it was just in the form of smaller monthly payments rather then a large lump sum. Think about it from a business point of view, if the insurance company wasn’t make more then they were paying out they would be bankrupt.
guinness416
February 14, 2008, 11:58

You should read Atul Gawande’s long but excellent piece on how doctors get paid, different payment models, insurance, etc at the New Yorker.
guinness416
February 14, 2008, 11:59

Hmm, there is a link hidden in that last comment, believe it or not.
Pinyo
February 15, 2008, 21:10

@AIB – I have some suspicion, but wow. This is bad. I always wonder why doctor prescribe the newest, most expensive prescription — when older, cheaper drugs work just fine.
@Rocket – It’s easier for some women. My mother in law is the same way.
@Adfecto – Seriously, I tried 6 dentists before I found the one I like. Luckily, I am in NYC so it’s not hard to find new dentist/doctor.
@Mike – Isn’t medical care part of the universal health care system in Canada?
@David – No problem. I can feel your paid. I hope you feel better soon.
@Jeff – “a doctor is paid to keep me healthy and stops getting money when I get sick” …that will never happen
@guinness – I know I have to fix this green on green thing
Cindy S
February 16, 2008, 17:05

It is a good thing to question your doctor. Too many people don’t and find out the hard way that doctors don’t always have the right answer. Too many times they just throw out stuff until something works and our insurance companies pick up the tab… and charge us more.
Helene Zemel
February 22, 2008, 4:06

You do have to check on what your doctor recommends. My pharmacist caught my doctor on a prescribing error due to her being rushed. Also, I notice that she always recommends the latest medication that the pharmaceutical companies recommend. Any time that I have gone to that office, I see a rep come to business. I always make sure to ask for a generic. You are much safer with older, time tested drugs.
Pinyo
February 22, 2008, 10:10

@Cindy – Exactly. People just don’t realize that we ended up paying for it anyway. That’s why premiums are increasing so rapidly.
@Helene – Thank goodness you are okay. I notice that with one of my doctor as well. There’s always a pharma rep there. For instance he always prescribe the latest allergies med when Claritin works great for me.
Make Friends, Earn Money
April 6, 2008, 8:21

It’s a shame when doctors move from being a trusted professional to a white collar villan, by abusing thier position of trust for financial gain. I think that doctors and other health care professionals are already well paid and it is shameful when greed comes into the equation.
Miranda
August 12, 2008, 13:32

I’ve been lucky in that my doctors have all be very trustworthy — sharing lab results over the phone and consulting me on them for about five minutes to answer my questions.
Twice a year? I only go in once a year (my female gyno’s suggestion), and my healthy almost 30-year old husband’s doctor told him that every two years is fine for now.