Thursday, January 19, 2006

 

Finally! Or, the True Moral Hazard of HMO's

The Girl is just over 18 months old. She’s walking, and talking (in her way), and laughing, and feeding herself with a spoon.

I mention that because the HMO finally finished paying the doctor who attended her birth.

I’ve read umpteen analyses/discussions/arguments about our health care system, and I’ve never seen anybody address the glaring loophole in HMO’s. Once you’ve actually been to the doctor, the HMO has no incentive to follow through and pay. None.

This one was particularly bad. (It rhymes with “shoe floss.”) As I posted last year, it initially refused to pay for The Girl’s birth on the grounds that she was not listed on the (family) policy when I joined my current employer a year before she was born. I politely explained that that was because she hadn’t been BORN YET. (I also raised the ontological question of what ‘childbirth coverage’ means if it does not, in fact, cover the birth of a child.) Apologies ensued, though payments didn’t. With the help of a beleaguered and indefatigable unsung heroine in HR, I’ve spent the last year and a half nagging them for payment. In the meantime, it calmly went on earning interest on the money it wasn’t paying my daughter’s doctor.

To recap: you aren’t allowed to have a baby unless the baby is already listed on your policy. You can’t list a baby without a social security number. You can’t get a social security number for a baby until after she is born, which isn’t allowed unless she’s listed on your policy.

This, in the name of efficiency.

Who benefits from this arrangement? I don’t – my credit rating was hanging out there for the last year and a half. The hospital didn’t. The doctor certainly didn’t. Hmm. Can’t quite put my finger on it…

To make matters worse, HMO’s are immune from lawsuits. So I can’t even threaten to sue. They know that, of course, so they take their sweet, sweet time to pay bills, tossing off progressively more ridiculous excuses while quietly earning interest on the money they aren’t paying.

How is that not stealing?

Since most people get their health insurance through their job, they don’t even have the option of ‘exit’ if they get jerked around. I was lucky to the extent that my employer offers a choice of several plans, so I was able (eventually) to switch carriers, just to punish this one. In some companies, I wouldn’t even have had that choice. I have no illusions about the one I switched to – it has the same perverse incentives as any other – but at least it hasn’t jerked me around yet. Then again, we haven’t had another kid.

A modest proposal: if we’re going to go the market route for health care, let’s at least hold HMO’s to the same standard as any other company. Failure to pay for covered services within a reasonable amount of time should be considered actionable breach of contract. If we can’t do the civilized thing and embrace single-payer, instead favoring the open brawl of the market, we should at least make it a fair fight.

In the time it took this multi-billion dollar operation to get around to fulfilling its obligation, a newborn learned to walk and talk. Give me a break.



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