Portrait of a Billion-Dollar Bill-Beater

A friend who runs a large physician practice calls them “bill beaters.”

In health care, NO ONE'S hands are clean: providers are conditioned by payers to overbill; payers are conditioned by over-billers to under-pay; and there are myriad 3-card monte dealers in the middle motivated to take more their pound of flesh. Patients always get stuck on the wrong end, and regulators and litigators aren't coming to anyone's rescue.

"Regulators rarely intervene. The administration of employer-funded health plans is mostly exempt from state regulations. Enforcement primarily falls to an agency within the federal Department of Labor, which says it has one investigator for every 8,800 health plans."

This is why ALL buyers of heath insurance plans -- employers, unions, and individual plan -- should caveat emptor. This is also why patients should stick to networks, and shows once again that the only way out of this miasma is the demand for actual price and reimbursement transparency up and down the health insurance food chain, not the marketing-buzzword version...