Insurers eroding doctor-patient trust
Published:Monday | May 13, 2013 | 12:00 AM
The professional relationship that exists between patients, health-care providers and the health-insurance industry goes three ways. One is between the patient and the health-care provider, another is between the patients and the health-insurance companies, and the third is between the health-care provider and the health-insurance companies.
Health-insurance companies are only viable if some clients do not use the benefits or only do so occasionally. If too many patients use the benefits, or if there is fraudulent use of the system (by borrowing the cards of others, stealing the cards from others, using the cards to fill prescriptions for others, submitting false claims or submitting inflated claims), health-insurance companies will have to increase subscription fees or face economic ruin.
In an effort to reduce losses from fraud and errors, Sagicor (Health) has been using text messages to patients in order to determine the validity and accuracy of claim submissions by service providers.
Although one employee of the company claimed, "Every patient receives a text," I have not been able to substantiate it. However, many patients receive texts that read, "Dear (patient's name), Call 1-888-724-4267 ONLY IF the charge of $ (amount claimed for) from (health-care provider's name/company) for Office Visit on (date in question) is NOT CORRECT."
Unfortunately, the vast majority of patients tell me that the text messages (which are often resent every time they visit their doctor) give them the impression that the health-insurance company is using them as watchdogs. They wonder if their doctor has committed fraud, is under suspicion of fraud, or has previously erred grievously in making claim submissions. Several concerned patients have asked what transpired between Sagicor and me.
terribly wrong
I experienced how the system can go terribly wrong when someone I have known for a long time forwarded this message to me: "Dear
Because the patient has known me and the office staff for many years, he concluded that it must have been an error on the part of the health-insurance company. On the date in question, he was only seen for a follow-up, yet the text message quoted a submission of $160,505! He called the (1-888) number but was unsuccessful in reporting the incredible error.
Having sent out that text and recorded no feedback from the patient, the system should have red-flagged that he was apparently charged that enormous amount for a regular office visit. However, he was never contacted for verification and I was never contacted or audited.
In other words, the text system failed abjectly in its objective. It turns out that the amount quoted came from part of my Provider Number - XXXX160505 at the very top of the page.
A telephone interview with someone from Sagicor revealed that the company texts patients to ascertain if someone used a borrowed card, used a stolen card, made a numeric error or if health-care providers are committing fraud. Guardian Life (Health Insurance) and others that I inquired about in the USA do not monitor health-care providers by texting their patients.
The patient-doctor relationship depends entirely upon trust. Using patients to monitor doctors severely and permanently erodes it. The problems attributable to doctors, like numeric mistakes (that sometimes come from within Sagicor) and/or the seemingly very few cases of physician fraud certainly, do not validate or warrant making all of us appear dishonest.
I hope that Sagicor will reconsider their current method and find a more discrete and accurate way of discovering if and where their losses occur.
Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.