Saturday, April 18, 2009

Can you pay me now?

Today’s Globe article says that Beth Israel Deaconess (our hospital) has stopped sending insurance claims data to Google Health to use as medical records. A patient finally pointed out that it could be a problem when his medical records falsely claimed that he had an aortic aneurysm and cancer in his brain and spine. I know that I was surprised to receive a postcard saying that I had multiple sclerosis a couple of years ago due to a similar misunderstanding of insurance claims data.

Medical providers want insurance companies to pay claims, because otherwise they don’t get paid. And insurance companies set up huge and complicated sets of rules that say that they’ll only pay for certain tests, procedures, and medications if the patient has certain conditions. So the medical providers routinely lie get creative with the billing codes. I think of it as insurance fraud, but medical providers and insurers think of it as just the way the system works. What’s the harm in telling the insurer that the patient has brain cancer if that’s what it takes to get the medically necessary MRI covered?

Apparently, the harm comes when a hospital forgets that their insurance claims are spun out of a fine blend of whole cloth and necessity, and starts conflating the deliberately false insurance claims with the only somewhat error-filled medical records. Then patients get outraged, and the media sees a fun story, and the hospital ends up admitting that they shouldn’t have pretended that their insurance claims were true.

I hate the resolution of the story. I hate that everyone accepts the idea that insurance claims should be filled with false information. The Globe and the hospital have used this story as an opportunity to explain why medical providers lie on their insurance claims, and to explain why insurance claims contradict medical records, but not to advocate for truth in billing. We don’t need an insurance system that practices medicine by spreadsheet, and we certainly don’t need to train yet more generations of health care professionals that lying is a core component of patient care.

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