Doctor Forgiving Deductible
QUESTION 38: DOCTOR FORGIVING DEDUCTIBLE
When our family goes to the doctor at the start of each year,
we must pay a deductible amount, after which the insurance
company pays most of the cost of the doctor visits. During
the period before our deductible is reached, our family
doctor lets us pay a portion of each visit now, with the
intention that we will pay the rest later in the year - even
though he reports the entire cost of the visit to the
insurance company. If later in the year, he forgives us our debt,
is that fraud?
It's not fraud if he decided later to forgive the debt,
because that's his personal gift to your family. In other
words, let's say his price is $50 a visit, and that's what
he reported to the insurance company, and that's what he
would charge ordinarily, and what he did charge, except
that some sort of payment plan was decided upon. And then
when he decided to forgive it, that's his personal decision.
But this shouldn't be done if he planned all this from the
outset. These things are done all the time - people pad the
bills and make believe that these are deductibles.
Perhaps I once told you the story I had with a deductible.
Many years ago I took a car to a body shop that I had crashed.
The car had collision insurance, but there was a $500 deductible.
The damage was about $8,500. So what did the mechanic do?
He padded the bill to $9,000; he got $8,500 from the insurance
company and he told me to forget about the deductible.
I took the car home, and the next day, I started the car and
it seemed to run, but there was a signal to go see the mechanic.
I took it to the mechanic and he told me the computer in my car
had been stolen (this was when they had just started putting
computers in cars). I asked him how could it be stolen without
breaking into the car. He said it's possible ... the thief stuck
his head under the car and unscrewed the computer and took it out.
I asked him how much it cost. The collision insurance didn't cover
this - it was theft. He told me it costs $500, exactly the amount
of money that I had 'saved'.
I felt very happy that at least the Ribono Shel Olam (G-d, literally
Master of the world) didn't let me hold on to the money that I
shouldn't keep - money that wasn't mine. I should have paid the
$500 to begin with, and the tainted money was cleared from my property.
You can't l'chatchiloh (from the outset) pad the bills and make
believe the deductible was taken care of. The action has to be
legitimate, because that was the type of the insurance you bought.
The insurance was like an item you purchased, that comes with certain
rules and restrictions. However, if the action is legitimate, and the
doctor forgives your debt, then there's absolutely nothing wrong.
You're really saying the law for the doctor - he can't l'chatchiloh
(from the outset) have this intention. But if he says to you, "Just
pay me now," and he has the intention to do this trick, what
responsibility is it to you as a patient?
How do you really know? One thing is certain. You could tell him
I'll pay you later. I want to meet my deductible. Thank you very much.
I'm paying $25 now, and I'll pay you the rest later.
But let's say you know that he has intentions to 'help' you later?
You can't make up an explicit agreement with him to do such a thing.
If it happened once, next year tell him, "Thank you, but I'd rather
pay the whole thing."
There's a reasoning used for permitting this practice, but I'm very wary.
The reasoning runs like this: If the doctor ordinarily charges $50,
but the insurance company would also pay when the doctor writes in
$75 - since that's what the Park Avenue doctor will charge - so
the insurance company will pay if he says it's $75.
Even though the patient is only paying $50?
Right. If the $75 is a legitimate cost because the insurance company
recognizes that as a legitimate price, there is a reasoning for leniency.
But I don't believe it is a correct one. The whole idea of deductibles
is that you should pay a certain amount and have the rest be insured,
It's designed that way so as to avoid frivolous use of medical services.
And that's the amount and the type of insurance that you purchased.
The insurance company knows it will cost them a certain amount if
they insure fully, and the sale price of the policy is determined
by that cost. If they insure it only beyond the deductible, it's
entirely different. It may then be primarily a 'catastrophe' policy
meaning that maybe for a couple of years they'll profit and then, should
a catastrophic thing happen, they'll pay a lot of money for it. If you
end up getting more than you purchased, so it's gezel (robbery) -
taking more than you purchased.
Thus the various justifications concocted by logicians don't address
the real issue. I've told you many times that I feel a slight deviation
from the regulations is not the thing that matters. The thing that
bothers me all the time is when a person ends up taking something
that's not his. He paid for one thing and he takes more - with some
kind of dreying mit dem grubben finger (figuratively: rationalizing
to his advantage). Whether he ends up taking twice as much, or 2%
over what he's entitled to, is immaterial. It's gezel (stealing).
Perhaps gezel is more damaging when it's accompanied by a 'sevoro'
(reasoning) because it corrupts your power of reason, which is the
holiest and most precious possession a person owns.
I once read an essay by Rav Shimon Schwab, zt"l, where he said that
the whole role of the sitra achra (the evil inclination) is to entrap
us into doing things just like this. Since I've read that essay,
I've wondered if it is possible that giving into the temptation of
krumkeit (crookedness) has a negative effect on our neshomah (soul).
It does. But just to refer to our case once more, if where I feel
that the doctor honestly intended to have me pay the bill, and then
later he forgave the bill, I have no liability. I can accept that
the doctor forgave the bill and it doesn't involve the insurance
company, nor is it 'pogem' (something that taints) the soul.
But what if there's a haromoh (trickery) going on?
The haromoh shouldn't be done.
NEXT WEEK'S QUESTION 39: SELLER REVEALING FLAWS IN A HOUSE
To what extent is one obligated to tell a potential buyer everything
that is wrong with a house? What must be told? If the pool has a
slow leak when the filter is on, is one obligated to tell that
to a potential buyer?
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