Then the paperwork came: $6,816 had been charged to insurance for four coronavirus tests. Ms. Sussman’s fees alone were $1,944.
She started looking through the itemized costs. One insurance claim showed that she had been tested for a dozen respiratory diseases. She found that odd; the town emails advertised only a coronavirus test. There was also a surprise $480 charge for a short phone call relaying her results.
To expand on that- in the NHS, this type of fraud conceptually doesn’t exist.
In all parts of the current UK, the Doctor would have been a salaried employee of the NHS, whose compensation would depend entirely on their skills and seniority. There would be no incentive to over-test. In addition, there would be no confusion about coding the treatment for reimbursement by the insurer, because there is no coding of treatments and no insurer. There would be no fight about the charges and copayments due to the patient, because they don’t exist either.
OK, I am going to use this as a platform to rant, so scroll past if you are not in the mood.
I have mentioned before that my pediatric office has rapidly morphed into a psychiatric practice, and that MH resources are thin, as they have always been. As of yesterday, developmental peds (this is mental health for kids <5yo and for autistic kids) at UVA froze their panels. They will not even talk to parents about appointments until early next year. VCU has a minimum 6 month waiting list. There is a clinic in Winchester that is not much better. Child Psych generally doesn’t see kids under 5 (which is actually appropriate) and therapists who will see kids are full and not taking new patients. I am out of resources entirely. Understand, this is not a rant against these providers, they are overwhelmed and seeing patients as quickly as possible, but just can’t do it at the pace required right now. (And MH visits are really not something to rush through.) The problem is the chronic neglect and underfunding, as well as stigmatization, of mental health in this country. I have hope that a Biden admin might have different priorities and help out, but this predates Trump. Years ago I had an opportunity to discuss this with a VA legislator and his response was “wouldn’t it be more efficient just to put more funding into law enforcement.” I think I bruised my jaw on the floor. So, my hopes are limited and I have no suggested answers and yes, just ranting pointlessly. We will muddle along doing the best we can, but damn, this should not happen in a country this wealthy. Thank you for all who made it through this.
it also means that inability to pay bail is causing overcrowded jails risking ( sorry, killing ) people convicted of crimes and those who aren’t. if texas suspended cash bail, both sets of people would have had a better chance.
every way you can look at the situation, it’s criminal
“Everything is now a pandemic. You have to end this business. I am sorry for the dead. We are all going to die one day. It is no use running away from it, running away from reality, it has to stop being a sissy country,”