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, 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.