How is it unfair to other insurance holders if you deceive diagnosis or treatment plan in order to help your patient pay for a necessary treatment that they cannot afford and if the insurance would not cover the procedure otherwise?
How is it unfair to other insurance holders if you
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Replace the word "unfair" with "moral" and you have your answer.
Fair/Unfair is a naive way to view the world. Cheating any company, no matter what you think is justification, is not moral. The word moral takes a 3rd person perspective while "fair" assumes a 1st person perspective. 3rd person perspectives tend to be more objective because you're considering everyone involved in the situation rather than just an individual.
Fair/Unfair is a naive way to view the world. Cheating any company, no matter what you think is justification, is not moral. The word moral takes a 3rd person perspective while "fair" assumes a 1st person perspective. 3rd person perspectives tend to be more objective because you're considering everyone involved in the situation rather than just an individual.
I understand perfectly well that the insurance company is losing money but how are the other insurance holders negatively affected through this? I'm not asking an ethics question. I want to know how the insurance works.
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The patient has a contract with the ins company and pays for that agreement. In turn the company upholds it. If you falsify documents so they can work around that contract how is that not wrong? or "unfair" as you understand it? It doesn't matter if it effects other insurance holders or not.
I said I knew it was wrong I'm asking how if affects other insurance holders. This is not an ethics question. It never was. I don't know how you interpreted it that way. Why am I repeating myself and why are you repeating yourself? I don't think you know the answer to my question.
My understanding is the it would alter actuary tables, because of increased utilization, the resulting effect on other holders would be an increase in premiums.
BTW: Your original post is written clearly as an ethical question. The subject of the post was fairness. Specifically, you asked "how it is fair" then provide an example of how some parties might benefit. So the topic and question was if things were fair according to the circumstances you described. Do you not see that?
BTW: Your original post is written clearly as an ethical question. The subject of the post was fairness. Specifically, you asked "how it is fair" then provide an example of how some parties might benefit. So the topic and question was if things were fair according to the circumstances you described. Do you not see that?
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I just realized there are two ways in which "how is it unfair" can be interpreted. First way (my interpretation), I implied to use "how" to question what mechanism the unfairness took place. For example how is the tide affected by the moon? This asks for the mechanism. The second way (your interpretation) is implying the "how" to mean "why." I can see how you could have been confused especially if you were sub-vocalizing my question with a nasally teenager voice. Anyways thanks.
And thank you.
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Yappy is spot on.
If you talk to dentists who have been in business long enough and worked with various levels of insurance, you'll probably hear now and then the story of how certain procedures used to always be covered without question, but overtime, as dentists began diagnosing and then adding more of certain codes, dental insurances became more scrutinizing and then some patients who needed a procedure were forced towait for authorization and sometimes got denied and had to then pay out of pocket. However, this is a little different than what you are talking about. From what you are saying, it sounds like you are talking about using lesser codes to get full coverage vs a higher code that only has partial coverage, which is different than what I just described.
If you talk to dentists who have been in business long enough and worked with various levels of insurance, you'll probably hear now and then the story of how certain procedures used to always be covered without question, but overtime, as dentists began diagnosing and then adding more of certain codes, dental insurances became more scrutinizing and then some patients who needed a procedure were forced towait for authorization and sometimes got denied and had to then pay out of pocket. However, this is a little different than what you are talking about. From what you are saying, it sounds like you are talking about using lesser codes to get full coverage vs a higher code that only has partial coverage, which is different than what I just described.
I think you should re-ask the question, since it is clearly baffling everyone.
But what I think you want to know is how would this affect the "other insurance holders" (which means all the other people in the nation that have an insurance plan through the same insurance company, don't know if that is what you mean or not).
You agreed the insurance company loses money by this scheme or yours. If the insurance company loses money, they charge everyone else higher premiums to make up for it. So everyone pays more the next year when you have to re-new your contract with the insurance company.
But what I think you want to know is how would this affect the "other insurance holders" (which means all the other people in the nation that have an insurance plan through the same insurance company, don't know if that is what you mean or not).
You agreed the insurance company loses money by this scheme or yours. If the insurance company loses money, they charge everyone else higher premiums to make up for it. So everyone pays more the next year when you have to re-new your contract with the insurance company.
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The all too often reality is that if you are trying to do the patient a favor by using a different code (or in some cases maybe even not charging for something) is that eventually it will come back to bite you on the butt! 😱
The sooner that one accepts this concept, the better IMHO
The sooner that one accepts this concept, the better IMHO
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