For reasons that will soon become apparent, I would like to share with you a joke I heard back at medical school. I will remind you that this was in Belgrade, Serbia in the early 2000s, but the joke would apply to any Serbian institution of higher education, or indeed any place anywhere in the world that uses oral exams I have heard these called viva voce in the US, which is a bafflingly cheerful-sounding name for a rather traumatic ordeal. to determine the final grade. Please also bear in mind that I am not the best at telling jokes.
Anyway, here it is. A not very well prepared student comes in for his Anatomy 1 exam with a rather erratic professor (the joke had the actual name, which I am sure changed from time to time and from school to school). While sitting in front of the office waiting for his turn, a teaching assistant (again, named) approaches him. “Look”, the TA says, “I know he can be tough but for 100 euros things would go a lot easier for both of you. I’m going into his office now so if you have enough with you I can pass it on.” It so happened that the student did have a fresh 100 euro bill with him, which he gave to the TA, who then knocked on the door, spent a few minutes in the office, then came out with a smile and a nod. With newly boosted confidence, the student did better than he could have hoped for and got a 7 (on a 5 to 10 scale). Beaming with pride for his academic savvy and mental fortitude, he winks at the TA hanging around in the hallway. The TA winks back.
So when the time came for Anatomy 2 Technically, there was no “Amatomy 1” and “Anatomy 2” but rather a mid-oral exam you had to do after the first two semesters where you got drilled about everything but the central nervous system, followed by the final oral exam in which everything was in play. Fun times., our student was even more confident and less prepared, and by now you should know where this is going. Same professor, same hallway, same TA coming in with an offer for the privilege to pay a 100 euro lubrication fee. Alas, the professor was in a foul mood that day and flunks the student within 10 minutes. Crestfallen, the student slouches out of the office and sees the TA. “So sorry about that”, says the TA while handing him back the 100 euros, “but you were so bad that there was no chance he could let you pass.”
The joke, if you can call it that, is that the professor was psychotic but not corrupt, and that the TA was playing a game of chance. If it works it works, if not, well, there is always the money-back guarantee. It is as close as you can get to a victimless scam.
A phone call my wife received this morning reminded me of the scheme. It was from someone presenting as staff from the Johns Hopkins billing department. Apparently, there was a balance past due, back from November of last year. This was only a courtesy call, you see, but would you like to pay now or set up a payment plan, to avoid it being sent for collection?
Between the six of us we get about two dozen Explanations of Benefit each quarter. I may not be diligent about looking at every line item, but if there is one thing our insurance company helpfully provides even without logging in to the portal and opening the PDF it is the amount owed. Now, if my wife and I were inundated with work the way we usually were something could have slipped through the cracks, but I was on paternity leave with more time than usual to deal with the overhead of living in the United States so I was pretty sure there was nothing we could have received from insurance that we would have missed.
Except for a pile of snail mail on our dining room table, which I collect about once per week. And there, in an envelope addressed to my wife, was an account statement from Hopkins dated last week — due early next month — that said that we did indeed owe just shy over half a grand for hospital services rendered last November.
This was the first we had ever heard about owing for these particular services, rendered in an in-network facility, performed by in-network physicians. And was that not a curious sequence of events, an early morning phone call urgently asking you for money you didn’t even know you owed until, at best, just the week before? I didn’t want that particular loose thread hanging over me on Tax Day of all days so there I was, HRA card in hand, ready to settle the balance online, until my wife who is as wise in the ways of health insurance and billing as she is in the ways of shopping asked me to cross-check the Hopkins statement with the insurance EOB before I did anything rash.
What a good thing I did, as they did not match. If you are lucky enough not to have to deal with American health care, this is how billing works: hospitals have a list price for their services which they pull out of thin air. Insurance companies have their own opinion about what those services are worth, and a hospital being “in-network” means that they have agreed on the insurance company’s price while “forgiving” the rest. On the hospital bill this will be the “insurance adjustment”. Well, the adjustment our insurance said they negotiated and what was shown in the Hopkins statement differed by exactly the amount Hopkins was now asking from us, which as an in-network hospital they were not allowed to do.
So now it was me on the phone calling the Hopkins billing department, asking about the charge, the person on the other end of the line checking — on a 15-minute muzak hold — what was going on, not finding out, promising a call back in 5 to 7 business days and not to worry about the collection because we will get to the bottom of this mysterious error (if it is an error at all, let’s wait and see) that the hospital made, happens very rarely, practically never, always in the hospital’s favor. I look forward to receiving a voicemail, 5 to 7 business days from today, telling me that the magnanimous Hopkins billing department staff has forgiven all our transgressions and that our balance was zero.
Back when there was such a thing as guidance on conflicts of interest for federal employees, it was drilled into and onto us that even semblance of impropriety, what social network warriors would tag as not a good look, was to be avoided at all costs. It does not matter if you did or did not mean to pick this contractor because your spouse works there — they may be the best company in the world for the job for all we care — you should not be involved in the decision. I agree with this now-antiquated viewpoint and propose extending it to scammy behavior or large corporations. It doesn’t matter whether you used a fake charge on a late bill to threaten collection while offering a quick solution with the express intent to defraud or if an unfortunate series of events led to only the appearance of a scam: it is not a good look. One that, unlike our fictional teaching assistant’s, can and does have real victims.