Maryland Injury and Disability Law : Washington DC Metro Injury & Disability Lawyer & Attorney : Greenberg & Bederman : Accidents, Falls, Medical Malpractice : Maryland, DC, Virginia

Are you tired of the runarounds, denials, and rate hikes of health insurance carriers such as Cigna, Aetna, Blue Cross/Blue Shield and United Health Group? Have you tried to take your business somewhere else? Have you ever tried to find a small, mom and pop style health insurance company in Maryland, D.C. or Virginia?

Good luck with that. There aren’t any.

Every health insurance option that you have in the D.C. metropolitan area is either a direct subsidiary of an enormous health insurance conglomerate or is an enormous health insurance conglomerate. “Taking your business elsewhere” simply means going to another company that will charge you exorbitant amounts of money for the same shabby treatment. 

The reason this is the case is because there is nothing keeping health care giants from buying out or muscling out any other health insurance company that tries to set up shop. Ordinarily, this would be called a “monopoly,” which is supposed to be against the law. It’s the reason that there is a Ben and Jerry’s and Baskin Robbins. It’s the reason that there is Coke and Pepsi, as well as RC or the generic version that you can buy at any supermarket. It is illegal for any one entity to corner the market of any product or service. The only two entities that are exempt from setting up monopolies are Major League Baseball and health insurance.

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Insurance Rules in the Metropolitan D.C. Area

Life in Washington, D.C. is different than other parts of the country, and that’s not just because of our proximity to Government. What’s different about our area is that there are essentially three different states within a ten minute drive of each other. There is Maryland, Virginia, and the District of Columbia, each separated by a few miles and each with separate governments, rules, regulations and requirements. We know that it doesn’t seem that way sometimes, but things are actually done differently in Maryland than they are in Virginia and vice-versa. And the District is essentially an enclave under the auspices of the U.S. Government. So if you decide to move across the Potomac at the 14^th Street Bridge the rules governing your car insurance requirements change, just as they do when you cross the Woodrow Wilson Bridge or the Cabin John Bridge. This doesn’t happen to people who live in, say, Central Illinois or Wyoming.

One of the main differences in the rules is the insurance minimums. These are the amounts that all drivers are required to have by law in Maryland and the District, but not necessarily Virginia (more on this later.)

In Maryland, drivers are required to have $20,000 worth of coverage to handle the bodily injury or death of another driver. They are also required to have $40,000 worth of coverage for the bodily injury or death of multiple people, be it the other driver and/or passengers. There is also a property damage requirement of $15,000, which is supposed to cover any damages to other cars or buildings or anything else that happens to be damaged in the event of an accident.

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We understand completely the idea of incentives in the workplace. If an employee does his job particularly well, we think a reward system of some kind makes perfect sense. Such a system is good for both the employee and the employer, as it encourages the employee to work harder while the employer reaps the benefits of those labors.

Performance based initiatives are great if you happen to be selling cars, or making donuts or tires. But we have a real problem with the idea of rewarding employees for denying crucial and needed services. And this is exactly what is happening with health care in California, and possibly all over the country.

A recent article in the Los Angeles Times details the inner workings of Blue Cross of California, in which employees are rewarded not for providing medical care, but rather for denying it.

“The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.”

Bear in mind that this employee was not rewarded for selling more policies, or cutting delays of payment, or even having a sunny disposition with customers. This employee was rewarded for cutting policyholders who might have actually cost Blue Cross money. This employee was rewarded for denying insurance claims. This employee was rewarded for leaving sick people in serious financial trouble.

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The Heathcare System and Medical Bills

Perhaps one of the saddest things about our healthcare system is that there is an occupation dedicated towards correcting what hospitals and insurance companies get wrong. And it isn’t the lawyers, believe it or not.

There are people out there called “medical billing advocates,” and their job is twofold: First, they make sure that all medical charges from the hospital are legitimate, and secondly, they help convince insurance companies to pay for medical claims that were denied for no good reason.

Most of them don’t charge by the hour. Just like injury attorneys, they charge as a fee a percentage of the money that they save you. While we are glad that such a position exists, we think it’s quite sad that they have to be in business at all. We are equally sad that business is apparently booming for them.

According to a group called the Medical Billing Advocates of America, there are errors on fully 80% of medical bills. And by “errors” they don’t mean mistakes in spelling in punctuation. We mean charges that are made that shouldn’t be there.

There are duplicate charges, price gouges, and “creative rebranding” of standard things in order to make them seem more expensive than they really are. For instance, one bill that was scrutinized listed a box of tissues as a “mucus suppression system.” A box of tissues at the average grocery store will run you $2.00. But a “mucus suppression system at the local hospital will run you $30.00. A second bill that was scrutinized charged some poor child $100.00 for the use of a teddy bear, which was billed as a “cough support system.” A single Tylenol, which is listed as “pain relief therapy”can cost you about $25.00.

Overnight stays also provide a billing bonanza for hospitals. Normally the room is supposed to have a flat rate, just like in the Holiday Inn. But quite often you will see surcharges for sheets, bedding, heating and/or cooling costs, extra blankets, and the electricity that it costs to run the television/adjustable bed/heart monitor.

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