I got stung this time. I was a mark.
My excuse is that this scam was a subtle one. I'd classify it as an occult emergent fraud. It's the third one I've met from Anthem Blue Cross/Blue Shield; health insurance is a breeding ground for these things.
... A recent industry survey found that in July 2007 over 80% of HSA plans provided first-dollar coverage for preventive care. This was true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals. All of the plans offered first-dollar preventive care benefits included annual physicals, immunizations, well-baby and well-child care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings ...
At first, and even second, glance this looks like a nice benefit. After all, HSAs are all about having individuals feel the true cost of care, so we will inevitably reduce our use of preventive services. Making those "free" seems to make a care plan less harmful.
The catch is, as I recently discovered, is that it can be quite tricky for an adult to get this benefit. The responsible physician has to choose to bill a care episode as "preventive". These visits, however, pay poorly -- they're only cost effective if they can be done very quickly. A physician, meanwhile, is legally and ethically responsible for overall patient health. Any adult over thirty, and many younger, has health problems that can, at the least, be reviewed to confirm all is well enough.
So the physician is biased to doing at least a moderate amount of work, which makes the preventive care payment uneconomical. So these visits will usually be charged as something other than preventive care, which means they come from the general HSA pool -- not the free preventive care visit. (Immunizations and such will be covered, but not the physician fee.)
This should be possible to study. What percentage of adult males, we could ask, actually manage to get their visits billed as preventive care services?
In my particular case I was steamed about being charged a Level III fee when I had worked quite hard to get my "free" preventive care visit -- including confirming with Anthem that it would be covered. I even complained about it to the physician's billing office. It was only when I worked out the angles that I realized I'd been stung, and that I just needed to shut up and pay up. It wasn't my physicians fault, or the fault of their billing office. It was just the way the system works.
I doubt anyone planned this out. It's just a happy coincidence that an expensive (to Anthem) benefit ends up not being used. The emergent fraud aspect is that once an unintended scam like this emerges, nobody will work very hard to fix it.
- Verizon scam: Emergent fraud earns a fine
- Emergence: how entropy and incentives create scams
- Emergent fraud: Anthem and automatic payment denials
- Memphis mortgages, complexity attacks and long term consequences
- Anthem - Putting the Hell in Health Insurance
- Causes of the crash of '08 - how much fraud?
Update 11/7/10: The "13 month preventive medicine" visit is a variant of this scam. Marketing and legislative presentations will claim a yearly physical is part of a plan. This does not, however, mean that one can schedule a covered preventive medicine visit on Nov 1 and March 3rd. In practice a "year" means "no less than 365 days apart". Many people fall prey to this trick.