Recently a colleague who I generally respect told me this is a contentious issue. Well that is his diplomatic way of saying not everyone thinks it’s a problem. It’s only stealing from insurance companies and that not unethical really. Again nonsense! What is contentious about being opposed to dishonesty? It about or should be as contentious as taking a stand against pick pocketing our patients’ wallets while they are on our couch. They trusted us and we deceive them. That is not altruistic.
Now of course what my colleague may have been referring to was the fact that while we are bound to collect co-pays by contract we are not bill collectors. Additionally, we wouldn’t be so heartless as to deny care if the client simply couldn't pay. He reminds me that we have hearts whereas insurance companies don't. Well hopefully that is true. But that’s not want I am referring to and my colleague knows it. Not collecting co-pay or anything for that matter when there is hardship is possibly altruistic however doing so on a routine basis is fraud. It is the routine waiving of co-payments that under discussion here.
Whenever the issue of insurance fraud comes up my colleague like so many other psychotherapists likes to deflect the conversation to the greed of the big bad insurance companies and how altruistic we therapists are. Of course if the insurance companies are that bad, why do mental health providers do business with them? There is no law that says we must. Perhaps it's like Willie Sutton the famous bank robber of the 1930s who when asked why do you rob banks said, “That’s where the money is”. But if that is the case we are no better or worse than they are.
That brings us back to greed. Only it may not be just the insurance companies and their execs that suffer from greed. If you have not as yet you may want to refer to my article, Do You Think This Orange Jumpsuit Makes Me Look Fat. In that article I have an “empty chair” conversation with one of my colleagues who argued that submitting a claim to an insurance company for phone calls and pretending that they were face to face sessions with clients was acceptable despite the fact that it is clearly insurance fraud. The same arguments that some use for that kind of fraud is also used by some of the same people for routinely waiving co-pays. The claim is that it for the clients benefit, but upon a closer look that doesn’t hold up at all.
Let’s take that closer look.
So waiving a co-payment when there is no document of hardship is altruistic? Altruism by any reasonable definition involves behavior that promotes the chances of others at a cost to ones own or some self-sacrifice for the benefit of others. It from the Italian: altrui or others. http://www.altruists.org/about/altruism/
When a therapist agrees to take less money isn’t that sacrificing? Well, ONLY IF they had a chance to make more money in the first place. However for some therapists the routine waiving of co-payments is simply a scheme to convince people who may not need therapy or really want therapy to agree to have therapy because it seems free. Some therapists need to resort to such practices since they can’t fill their schedules and make a living the honest way. But, it is not free. The insurance company is then paying 100% of the fee, which is more than their contracted share. It’s a scheme. And it is fraud. If a psychotherapist truly wanted to be altruistic to someone in need they could do any number of things that would be a sacrifice. They could bill every other session or simply not bill the patient at all and provide the service pro bono or free. That would be truly altruistic.
To show to what absurd or sneaky lengths some mental health professionals can descend to let me relate the following that was suggested on a prominent PhD social worker licensed by the state of NY and the owner of very popular Yahoo internet discussion group of over 800 mental health professionals. Last September this social worker actually reported on a practice or agency that came up with a rather unique scheme. They had their receptionist hand the client the money for the co-payment and then the client would turn over the money to the therapist. The listserv owner actually applauded this as an ingenious way of getting around the issue of those pesky insurance company policies and also states it was none of the insurance company’s business where the patient got the money for the co-payments.
Well I recommend that anyone who thinks this is a perfectly acceptable and ingenious method to go to their nearest grammar school and consult with a group of reasonably intelligent of 10 or 11 year olds. Explain the ingenious process of handing the receptionist the co-payments only for them to hand the money back to the therapist. Listen to the children’s reaction. Watch the expression on their faces. Would children think this is ingenious or dishonest? Is this what these therapists teach their children?
Until recently I could not understand how anyone would be so foolhardy as to think that such a silly scheme would be worth attempting. Even if an independent practitioner or agency did manage to convince a bunch of patients to go along with this scheme the penalties of getting caught would be severe. The risks simply would not justify the few dollars one could make by convincing a few patients to accept therapy when under ordinary circumstances they would not want it or be willing to pay any amount for it.
However recently a colleague alerted me to a possible explanation of why someone would take such risks. In was an article published in of all places a Readers Digest. The November 2006 issue has an article, Your Medical Records Stolen: How to Protect Yourself by Max Alexander. In that article there is a list, “Six Ways to Protect Your Medical ID” And in it there is a warning about health care providers who routinely offer to waive co-pays and other freebees. It as often as not is a scheme to steal patients medical ID and that can be sold for big bucks and cost patients dearly.
Is that why all psychotherapists would routinely waive your co-pay? Well not all, but how could one tell? If they are willing to cheat and steal your insurance company, which is what routinely waiving a co-payment, is, what would prevent them from doing to a patient you when it is convenient or expedient? Can we assume such people only steal from the rich and powerful?
Crooks tend to be equal opportunity crooks.
