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**MARCH 6, 2023**
Kuttner on TAP
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**** Health System Parasites:
Example No. 452
Middleman companies contract with insurers to find someone else to pay
medical costs.
The teenage son of a friend broke his arm in a playground fall. Their
insurance company, Health New England, paid the hospital bill.
Then they received a letter from something called EXL advising that the
injury "may have been caused by an act or omission of another person or
entity." In which case EXL would go after said entity to pay some or all
of the medical bill, thus saving Health New England some money. EXL
demanded that my friend fill out an extensive form about the
circumstances of the accident.
OK, how do you assign blame for a playground fall? Were other kids
perhaps playing tag or touch football with the boy? Maybe they should
pay some of the costs? Might the recess patrol have been insufficiently
vigilant? The whole premise is nuts, and insulting.
But it is part of the game of paying layers of middlemen to maximize
profits and shift costs. And of course the middleman profits, and the
bureaucracy created to administer this latest subsystem, all come out of
money that would otherwise go for patient care.
Is it even necessary to point out that in a universal system, where all
medical costs are simply covered, none of this would be needed or
permitted?
This gimmick is a second cousin to workers' comp, where insurers try
to prove that an injury or illness was work-related, in which case they
can shunt you to the benighted workers' comp system, where the care is
usually inferior to standard care. That would also be unnecessary in a
true universal system.
This latest middleman scheme even has a name. It's called
"subrogation." According to the website of EXL
<[link removed]>,
the process of subrogation-shifting the costs to someone else-can
save insurers millions, while EXL takes its cut. EXL does the
investigation as well as the dunning for payment.
Says the website: "At EXL, we leverage human ingenuity, deep domain
knowledge, extensive data analytics, and proprietary digital tools to
provide transparency, insights, and communication throughout the entire
process, resulting in better member engagement, efficient resolutions,
and timely savings, all while creating a positive experience for you and
your members."
Sorry, EXL: My friend did not experience the demand for details of her
son's injury as "a positive experience" but as yet another assault.
What arrogant BS hiding in corporate jargon.
Insurers are regulated. Their subcontracting with firms like EXL to
devise ways to threaten patients and shift medical bills is a pure drain
on the system, a waste of time and money, and should be illegal.
~ ROBERT KUTTNER
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