The Wall Street Journal’s Health Blog asks (Is Your Spouse Really Your Spouse? A Dependent Audit Wants to Know). Companies that offer benefits to their employees and dependents don’t want to pay health care costs for husbands and wives who aren’t the real thing. So they hire companies to check up on people to make sure they’re legit.
I haven’t experienced this particular kind of checking myself (perhaps because I own my own business) but it seems like just about every time a dependent or I have a claim we get a letter from some kind of auditor working for Blue Cross Blue Shield of MA wanting to make sure the charge is appropriate. Usually the instruction is to call a “recovery service” –typically done via interactive voice response– and answer some questions.
It’s kind of annoying and time consuming so I usually blow it off. Typically that results in another letter or two and then they give up. Maybe if I cost them more or triggered more doubts they wouldn’t give up so easily.
On average these interventions probably reduce costs to the insurance company or employer, otherwise they wouldn’t be sustained. Still, the spouse example shows pretty clearly a cost of having a patchwork of insurance plans rather than universal coverage with a single payer. In a single payer system it really doesn’t matter who’s married to whom or whether kids have aged out of their parents’ coverage, since everyone is in the system.
These kinds of checks are particularly onerous for people who are sick –just the ones who don’t have the strength to wade through all the requests or demands.July 21, 2010