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Health Scam – The pitfalls of modern medicine
July 14, 2007
By: A.Retlick

Disclaimer: The author is not responsible for any negative feelings derived from reading this document. The contents herein may not be used in any form without written permission from the author.

Before I sat down to write this article I spent a lot of time thinking about how I was going to do it without turning it into a rant against the whole healthcare industry. I have not seen Michael Moore’s Sicko movie, but I am sure he had no shortage of material to choose from while he was producing his latest documentary. I have been relatively healthy in the past ten years, so I don’t have a lot to complain about. But my girlfriend has not been so lucky. It all started about three years ago when she began having fainting spells at work. She works in the retail industry and as you can imagine, it is quite embarrassing when you collapse at work. At that time she was covered under a form of healthcare insurance that only covered major medical procedures. It is a form of insurance that is sometimes available through an employer while you wait to be eligible for regular healthcare insurance. She told me that her condition was a result of low blood sugar, which can make you dizzy and light headed if you don’t keep it under control. So, after passing out a few more times she starts to wonder if her condition hasn’t progressed into something worse.

After much deliberation, knowing that she had inadequate insurance, we decided to visit a clinic to see if they could test her blood sugar to determine if she had some type of diabetes. I learned that going to a clinic is like going to a fancy restaurant without any prices on the menu and having someone in a white coat tell you what you are going to eat. The young female doctor who saw my girlfriend was aware of the limited healthcare coverage that was in place and was made aware of the low blood sugar condition. Even so, the doctor scheduled an MRI and several heart monitoring tests. At this point we probably made a mistake by following through with the prescribed tests. But doctors do hold a certain air of authority and it can be difficult to challenge their orders. The tests found nothing. The doctor next ordered what is called a “tilt test” at a facility that was out of town. During a tilt test, they basically strap you to a rotating table and monitor your condition while they rock you back and fourth.

At this point I was not willing to drive to another city for another test. The doctor offered to simulate the test at a local facility, but that only made it seem like they were avoiding the diabetes test that was originally requested. So we stopped visiting the clinic, which is hard to do because you have to resist a doctor who is trying to schedule another test or office visit. A few months later the bills for the tests started coming in. It turns out that an MRI test is very expensive. My girlfriend tried to explain to them that she felt that the tests had been unnecessary. They continued to call almost everyday asking for payment. My girlfriend had to have her phone number changed in order to stop the harassment. They have since hired a law office to continue their collection efforts.

So what lessons can we take from this example? Number one: don’t go to a clinic if you don’t have good health coverage. There are other options like urgent care clinics and online health information web sites, which can help determine if you have a serious condition. Number two: ask how much each test is going to cost. By asking more cost related questions it will make the doctor aware that you are concerned about expenses. Don’t be afraid to challenge a doctor if you know you are right. Number three: if you suspect that a doctor has somehow mistreated you, write a letter documenting your complaint and send it to whoever is reviewing your case. Even though it may seem like holding payment is our only defense, the collection agency may not be aware that you are unhappy with the services you received.

Part 2: Workers Compensation

If you are unfortunate enough to be injured at work, there is a form of State funded healthcare insurance that may be available to you. There is a time limit on filing a claim and the laws governing it can be complicated. I have never filed a workers comp claim and I am generally not fond of State or Government funded programs because they tent to be complicated and constantly under suspicion of abuse. This story involves my girlfriend again. About two years ago she injured her back while at work. At the time she did not have full healthcare coverage and workers compensation was her only option for getting treatment. She was directed to a local clinic that had a department specifically for people who were using workers comp to pay for their injuries. Not being familiar with Workers comp, I thought it was unusual that they would have a separate area and set of doctors for handling people with work injury claims. But the more doctors and therapists we visited, the more it became apparent that workers who are injured on the job are perceived in a different light. It turns out that the majority of workers comp claims in the United States are for back injuries. Unfortunately, back injuries are one of the most debilitating and difficult injuries to treat.

As with most injuries of this type, after a series of tests, exercise therapy was ordered. Progress was slowly being made over the course of several months. Then unexpectedly, a letter came ordering my girlfriend to visit another doctor for a second opinion. This doctor, selected by the workers comp office, looked like a budget chiropractor with signs advertising low cost services on the outside of their building. Reluctantly she went in and had an examination. Shortly after that, she received a letter saying that she was cured and that all healthcare payments would stop immediately. This was interesting because her initially assigned doctor was still prescribing treatments. Bills started coming to the house for therapy that was still in progress. Even though she was not fully recovered, she had to stop seeing her doctor and figure out how to pay for her mounting medical bills. To my great surprise, she was advised by her doctor to get a lawyer to help settle her claim with the workers comp people. Apparently this is standard procedure.

Finding a lawyer who specializes in workers comp claims is not too hard. The workers comp doctor has a list and you can also talk to people in the waiting room who have all had to get lawyers. The lawyer collected all the bills and got signed affidavits stating that the injury was real. The lawyer also recommended getting opinions from several more back specialists. Unfortunately there is a negative workers comp bias among many doctors and they are less than supportive. This could be because they know that they may not see payment for their services for some time as the injury claim gets contested. Meanwhile the bills and collection notices continue to arrive. I don’t hold much hope that there will be any settlement out of this. You may have better luck if you have chronic pain that clearly requires surgery. But since the majority of back injuries are not treated by surgery, you will have a difficult time getting your outstanding bills paid when workers compensation decides that you have been cured.

So, what knowledge can we gain from this example? First, if you have adequate health insurance, don’t mess with workers comp unless you fully understand how it works in your State. Any process that requires a lawyer to resolve is something to be avoided. There could be either a dollar limit or a time limit on the amount of assistance that worker’s comp will provide. Your medical records in these cases are often under separate rules that do not require your permission for release. Unless your injury is clearly visible you are going to feel discrimination from people who think that you are making a false claim.

As a side note to conclude this article, I believe that starting a healthcare saving account is a good idea. But there should be more incentives for having one. Maybe automatic State funded contributions or some type of account balancing that distributes money from deceased participants to people who have more medical expenses than anticipated. With all the negative things I hear about HMO’s, they do serve us by trying to control costs. Sometimes their cost control efforts conflict with prescribed services, but overall someone needs to oversee how much we are being charged for medical services. Unfortunately we are often left to pay the difference. Each year our health insurance premiums are increasing by double-digit percentages. If something is not done soon, only the rich will be able to afford any type of professional treatment. We have a broken healthcare system in this country and we are all to blame.

-AR-