"What troubles me about whistleblowing is that the overbilling practice is so pervasive that I can't believe the HMOs don't already know about it."
You never know, but every complaint (i.e., informing them of the truth) helps.
Here's an example: My city was sending out "estimated" tax bills to non-filers, and threatening to ding their credit if they didn't pay. When I pointed out a fake bill, sent out on a non-existent balance due, could deny the person a job, or an apartment, the Commissioner's assistant assured me that it was okay...they really didn't send the delinquent bills to a credit company that would ding credit.
Did you catch that? That's the good news: the city was lying to the public under the color of authority.
I demanded a meeting with the Commissioner and my City Council rep. The CC guy in charge of the tax department was there, along with six other lawyers and assistants. You should've seen the look on the CC guy's face when he heard the city was lying to its constituents.
That threat was gone in the following year's notices.
Cigna was my Rx provider at one point, and I was late ordering a daily maintenance drug for my thyroid. It was Friday, so I chose "overnight delivery" for an extra $17.50.
The Rx didn't arrive the next day. Or Sunday. Finally it arrived Monday, so I called Cigna to get my "overnight" money back. "You didn't choose "Saturday Delivery"", I was told. We went to the website, and I asked her to find "Saturday Delivery". She couldn't. Did that mean I'd get my money back? "No", she explained, "we're not responsible for how many days it takes to fill your prescription".
I pointed out "overnight delivery" is pretty worthless if it's not overnight.
I then had to keep going up the ladder, even after folks said I'd get a refund that never came, for over six months. But finally, two things happened: I got finally got to a company honcho, who was appalled at my treatment and immediately sent my full refund...
...and Cigna put a disclaimer on their website about "overnight delivery does not include processing time".
Some win, huh?