Sunday, December 22, 2019

$677 For A Session Of Acupuncture Or Physiotherapy!!

Posed picture with Rachel
Recently I had a patient who rang me up saying he had right shoulder pain and he wanted to go for a MRI scan to rule out anything sinister. He asked if I can recommend him a doctor to hospitalize him and then do whatever necessary tests that was required. I told him that for a MRI he need not be warded. Then he said that if he was not warded he would have to pay for the investigations in full .....

I had to politely decline as I thought it wasn't right to make insurance pay for the scan if a patient does not want to foot the bill.

So I'm not surprised to read that there are mercenary physiotherapists, chiropractors etc who take advantage of the insurance system to bill excessively.

In New Jersey, school employees are covered by the state's School Employees' Health Benefits Program. This plan covering school teachers covers virtually anything the "out-of-network" providers charge.

In 2018, the teachers' plan paid out an average of more than USD $600 a visit to acupuncturists and physiotherapists! This is even higher than out-of-network fees of psychiatrists and gynecologists.

As a result, more than 70 acupuncturists and physiotherapists earned more than USD $200,000 in 2018 from their teacher clients alone. Data also showed that one acupuncturist earned more than USD $1 million dollars!!

To further sweeten the deal, some of these providers are suspected of waiving a co payment by the teachers so there is no out of own pocket payment by the teachers.

The same state fund paid out USD $11.2 million dollars to a clinic -Thompson Healthcare and Sports Medicine for providing chiropractic services, acupuncture and physiotherapy to teachers.
Thompson Healthcare and Sports Med during a school visit
Investigations by the state showed that these payments consumed hundreds of millions of dollars in the last four years. This has possibly affected all residents in New Jersey as homeowners in towns where the schools are located are all paying higher property taxes.

Six people (half are union members) make up the state panel overseeing the benefit plan have not done anything to stop the runaway costs. This is despite meeting transcripts showing discussions regarding this since 2014.

All these data and documents, along with interviews with state officials show this is what happens when savvy (and mercenary) health care practitioners find lucrative loopholes in a loosely designed employee health plan.

As expected, the teachers' premiums have increased by 8 and 13 percent in the last two years. The most popular family premium plan cost in excess of $36,000 a year. This is nearly twice the cost in other parts of the country.

I dare say that if the teachers realized the exploitation of the plan, they will definitely think twice about how they use their health care benefits.

Back in in Singapore, there was an article in the Today Online paper regarding some physiotherapists in private practices paying doctors and surgeons kickbacks to get patients referred to them.

You can also read our other blog, where we have previously written about these kickbacks in our Singapore Healthcare system too. Needless to say, private medical clinics and MRI/ X-ray companies in Singapore are implicated as well.

It is bad practices like this that will lead to increases in our health care visits, insurance premiums and Medisave-approved Integrated shield plans.

You can read the article I referenced here.

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