Plan Fiduciary Vents

“……..I think we should turn XXXXXXXXX over to the District Attorney’s office to be prosecuted for price gouging. I’m pretty sure that’s a criminal offense…………..”

Below is a redacted email received this afternoon from one of our clients. The author is the owner of the company that sponsors a self-funded health plan. Claims are paid  on a Cost Plus 12% basis (www.costplusinsurance.com ), or Medicare +20%, whichever is greater. The Plan, of course, did not pay these outrageous bills. On the $150,000 bill the Plan paid $1,200 (yes, one thousand two hundred dollars) which is Medicare +20%.

…..$163,000 for a back surgery is pretty stiff. Still doesn’t beat $150,000 for a bilateral carpal tunnel release, but it’s close. I guess they have no shame. How’d you like to be the sucker who doesn’t have any insurance and no one to run interference between you and these criminals? Kind of makes you think the mob is kind.

I’m thinking of a reality TV show: “The Most Outrageous Prices for Medical Services You’ve Ever Seen”. I’ll bet we’d have a lot of entries – and would expose a lot of these shenanigans.

You wonder why I want to get second opinions on back surgery – here is the prime example. Except that this person sounded (when you presented her symptoms to me) like she had a relative emergency. But without someone reviewing medical records, you really don’t know.

In any case I think we should turn XXXXXXXXX over to the District Attorney’s office to be prosecuted for price gouging. I’m pretty sure that’s a criminal offense, and people can go to jail. We’d just need one
administrator to go to jail (or the threat of going to jail) to have a chilling effect on the prices these places charge. Oh well, I can dream……..

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