Have you tested positive for COVID?

[tridacna]

Does that circumventing involve lying about having symptoms?

Nope. You just say that you’ve been near someone positive and you need a test. It’s really not that hard. In NJ, we have free PCR testing anyway. No need to go to a rip-off center. Lots of those around.

 

[Storker]

Just the other week, I learned that my alma mater is donating a bunch of their test kits to Nepal. This spring, the world's test kit production capacity was seriously strained, so some folks there got together to develop an alternative test kit. Which was approved less than a month later and proved to be more sensitive that any test kit on the market.

This is what can happen if you're willing to pay for the luxury to have some eggheads playing with stuff most folk can't see the point in. Those eggheads know a bunch which most of us don't, and their toys sometimes prove invaluable in a crisis.

 

[Esprise Me]

Nope. You just say that you’ve been near someone positive

Even if you haven't?

 

[tridacna]

Even if you haven't?

I know. These magnanimous health insurance companies are always fighting for us. Wanting to help and be on our side. Always there to protect us and never deny us. Financial considerations are never an issue when when it comes to our health. We're so lucky to have them in the USA. Denial of benefits is never an issue with them. Denying treatment or drugs? No way. Unless you're the president. I'm not so f**k them.

 

[uncfnp]

I know. These magnanimous health insurance companies are always fighting for us. Wanting to help and be on our side. Always there to protect us and never deny us. Financial considerations are never an issue when when it comes to our health. We're so lucky to have them in the USA. Denial of benefits is never an issue with them. Denying treatment or drugs? No way. Unless you're the president. I'm not so f**k them.

In my position I see both sides (well really three sides), the ridiculous hurdles/obstacles health insurance companies go to in order to avoid payouts, in both coverage to insured and to providers, but also the overuse and abuse the insured can do, (forgive me) but especially whenever something is “free.”

Even if you haven't?

I would never encourage you to lie but sometimes one may need to “interpret” the question. At this point in time unless one is a hermit one has had some level of exposure. On our intake it’s now. Exposure? Yes or Maybe

 

[Esprise Me]

In my position I see both sides (well really three sides), the ridiculous hurdles/obstacles health insurance companies go to in order to avoid payouts, in both coverage to insured and to providers, but also the overuse and abuse the insured can do, (forgive me) but especially whenever something is “free.”
I would never encourage you to lie but sometimes one may need to “interpret” the question. At this point in time unless one is a hermit one has had some level of exposure. On our intake it’s now. Exposure? Yes or Maybe

I'm pretty sure the question isn't whether you could possibly have been exposed to anyone who might possibly have COVID. I'm sure it's worded clearly. And @tridacna came right out and described his method as a way of circumventing the requirements designed to provide tests only to those who were at risk, so that he could get the test required for his vacation covered.

I would feel differently if we were talking about someone who needed a test in order to go back to work and couldn't afford one because he needed the income first. It would still be fraud, but it would be understandable from someone in dire straits.

But fraud is part of why health insurance is the way it is. It's not the only reason, arguably not even the biggest reason. But it's part of it. The high premiums, the insane level of scrutiny over every claim, the rigid limits on coverage-- those things wouldn't be necessary if everyone were honest. And it doesn't even take everyone being honest to make a difference.

A shopkeeper in a safe neighborhood may work alone and merely lock his door at night. There will be some loss, but it's cheaper to write it off than to spend more on mitigation measures. As theft rises, he may decide that hiring security and installing alarms and cameras is worth the cost if it reduces his losses. But there will still be a cost, which he'll have to pass along to customers in the form of higher prices. Maybe he's a jerk who gouges people anyway on toilet paper when it's scarce. And maybe you think that justifies you swiping a pair of sunglasses you don't really need. Maybe you don't think you're part of the problem. But you're wrong.

 

[uncfnp]

I'm pretty sure the question isn't whether you could possibly have been exposed to anyone who might possibly have COVID. I'm sure it's worded clearly. And @tridacna came right out and described his method as a way of circumventing the requirements designed to provide tests only to those who were at risk, so that he could get the test required for his vacation covered.

I would feel differently if we were talking about someone who needed a test in order to go back to work and couldn't afford one because he needed the income first. It would still be fraud, but it would be understandable from someone in dire straits.

But fraud is part of why health insurance is the way it is. It's not the only reason, arguably not even the biggest reason. But it's part of it. The high premiums, the insane level of scrutiny over every claim, the rigid limits on coverage-- those things wouldn't be necessary if everyone were honest. And it doesn't even take everyone being honest to make a difference.

A shopkeeper in a safe neighborhood may work alone and merely lock his door at night. There will be some loss, but it's cheaper to write it off than to spend more on mitigation measures. As theft rises, he may decide that hiring security and installing alarms and cameras is worth the cost if it reduces his losses. But there will still be a cost, which he'll have to pass along to customers in the form of higher prices. Maybe he's a jerk who gouges people anyway on toilet paper when it's scarce. And maybe you think that justifies you swiping a pair of sunglasses you don't really need. Maybe you don't think you're part of the problem. But you're wrong.

What if you answer no and you actually have been? Have you eaten in a restaurant the past 2 weeks? Been to an event? Gathered with family? Few things in life are black and white and sometimes it truly does come down to judgement. For us, every single patient is a covid suspect, even the twisted ankle visit.

What we see more are people that were symptom free one moment that have symptoms the next in order to get the test they want.

 

[formernuke]

I'm pretty sure the question isn't whether you could possibly have been exposed to anyone who might possibly have COVID. I'm sure it's worded clearly. And @tridacna came right out and described his method as a way of circumventing the requirements designed to provide tests only to those who were at risk, so that he could get the test required for his vacation covered.

I would feel differently if we were talking about someone who needed a test in order to go back to work and couldn't afford one because he needed the income first. It would still be fraud, but it would be understandable from someone in dire straits.

But fraud is part of why health insurance is the way it is. It's not the only reason, arguably not even the biggest reason. But it's part of it. The high premiums, the insane level of scrutiny over every claim, the rigid limits on coverage-- those things wouldn't be necessary if everyone were honest. And it doesn't even take everyone being honest to make a difference.

A shopkeeper in a safe neighborhood may work alone and merely lock his door at night. There will be some loss, but it's cheaper to write it off than to spend more on mitigation measures. As theft rises, he may decide that hiring security and installing alarms and cameras is worth the cost if it reduces his losses. But there will still be a cost, which he'll have to pass along to customers in the form of higher prices. Maybe he's a jerk who gouges people anyway on toilet paper when it's scarce. And maybe you think that justifies you swiping a pair of sunglasses you don't really need. Maybe you don't think you're part of the problem. But you're wrong.

I agree with your principle however the health insurance companies take it to far.

When I was 17 I tore the ACL in my left knee despite having constant instability problems the health insurance would only allow x-rays which showed normal. It wasn't until a year later when I started tearing cartlidge as well because of the torn ACL that they allowed the MRI. Why because MRI's are expensive. So I got 2 surgeries instead of one and a year of pain and knee buckling because they wanted to save a few bucks.

I guess it backfired though as they had to pay for 2 surgeries instead of 1.

 

[Esprise Me]

What if you answer no and you actually have been? Have you eaten in a restaurant the past 2 weeks? Been to an event? Gathered with family? Few things in life are black and white and sometimes it truly does come down to judgement.

If only I had asked @tridacna if he were using his best judgment when he claimed to have been exposed to get a free test instead of assuming he was deliberately lying. Oh wait.

Even if you haven't?

I know. These magnanimous health insurance companies are always fighting for us. Wanting to help and be on our side. Always there to protect us and never deny us. Financial considerations are never an issue when when it comes to our health. We're so lucky to have them in the USA. Denial of benefits is never an issue with them. Denying treatment or drugs? No way. Unless you're the president. I'm not so f**k them.

 

[tridacna]

I'm pretty sure the question isn't whether you could possibly have been exposed to anyone who might possibly have COVID. I'm sure it's worded clearly. And @tridacna came right out and described his method as a way of circumventing the requirements designed to provide tests only to those who were at risk, so that he could get the test required for his vacation covered..

Please quote where I mentioned vacation. I'm waiting...

Did I state that I had done this myself? When?

I worked as an actuarial consultant for a health insurance company. I know how badly we are being screwed. First, look at the size of the CEO's yacht then discuss health insurance fraud. Infinitesimally small part of their costs.

Here's really why costs are so exorbitant:

Sutter Health will pay $575 million and adopt pricing changes to settle antitrust case.

Feds amassed $2.6 billion from 2019 healthcare fraud cases

Fraud BY healthcare companies is rampant. Kickbacks from pharmas to healthcare companies? Really. If the average American had any idea how bad it was...

Back to Covid now...