Managers' scammed with medical policy

Supposed major medical insurance agents offer patients and their families to reduce the cost of emergency hospital care, "help" that ends up increasing the bill they must pay. Lucía and Manuela were separate victims of this type of fraud. Neither of them met the agent in person, who could only be contacted by telephone or messages and who made them go through a ordeal to get to the hospitals.

Lucía suffered a broken limb after a fall; since she was unable to contact the agent with whom she had purchased her major medical insurance, she turned to a woman who promised to squeeze her policy: "The insurance companies hate me", she recalls the consultant telling her, who promised her that she would not pay deductible or coinsurance, despite the fact that these are two fixed amounts from the moment she signs the contract with any insurance company.

The consultant made her go to two hospitals, in the first one Lucía was warned that she would have to pay all her expenses, in the second one she was admitted, but they began to submit her to tests that later another doctor told her were unnecessary, which increased the hospitalization bill and increased the payment she had to make to leave the hospital.

"I had no idea about my plan and everything, and she told me that I wasn't going to pay anything, that she was giving me a pass and that when I arrived I would have everything ready, that it was just to get in.

"I already had my X-rays, but I arrived and they sent me more and, when the technician was doing them, he told me I didn't need them; then they operated on me, my stay was very long, they did tests I didn't need, all with the promise that, according to me, I wasn't going to pay anything. However, when Lucía was going to be discharged, the manager changed her speech. She told her that she would have to pay the deductible and coinsurance, and that these would be reimbursed. This never happened, and her family had to mobilize to get the money, which they are still paying. Lucia says that, at the time, she did not give importance to the fact that the consultant never talked about the cost of her service. Now, her doubt is what was the profit she obtained for the case. A MODUS OPERANDI After her husband had an emergency due to illness, Manuela sought out the supposed consultant. From that moment on, the application of dozens of tests and analyses followed, which, as they accumulated, increased the bill until it became unpayable. Some of the studies even put the patient's life at risk, since they exposed him to radiation.

"They told us (that) either we had to leave the hospital and pay the bill of hundreds of thousands of pesos or let my husband undergo more and more studies and the bill would continue to grow," she said. Then we got the money, we took him to a doctor and they told us that the radiation to which he was exposed was dangerous, that it was not necessary and that from the first study we could see that it was an allergy. Doctors and insurance company personnel have warned about the modus operandi of the scam.

They point out that this is a network similar to the one that operates "dummy" ambulances, which charge for taking patients to hospitals, "without caring how far they can take a person, they perform studies and even operate for a commission and their hook is that they say they have agreements with the hospitals and that is why they don't charge you, but you end up paying an inflated amount for the "cuentonononón"," he lamented.

Maricarmen Montenegro, a specialist in Clinical Psychology and Criminal Science and Criminal Policy, pointed out that there is a black number of cases in which people seeking medical attention fall into the hands of fraudsters, who are apparently in collusion with hospital personnel. Those who suffer from these frauds also face economic, physical and emotional consequences for not being able to pay. Health has become an unthinkable trade," said the specialist, "They operate in an unethical way, they don't care about the health of others. For the expert, the underlying problem is that the right of access to healthcare is not a guarantee provided by the authorities. Meanwhile, she said, social security beneficiaries do not always have access to quality services or qualified personnel, so they end up turning to private services where the high costs end up implying patrimonial sacrifices.

Manuela, victim of fraud "They told us (that) either we had to leave the hospital and pay the bill of hundreds of thousands of pesos or let my husband undergo more and more tests and the bill kept growing". Lucía, victim of fraud "They operated on me, my stay was very long, they did tests I did not need, all with the promise that, according to me, I would not pay anything". Maricarmen Montenegro, specialist "(The services) work in an unethical way, they do not care about the health of others. If something generates problems, it is health, if you add to that the economic problem, then it gets worse".