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Insurance Fraud

Insurance Fraud

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by: fcabanski Active Indicator LED Icon 16 OP 
~ 6 years ago   May 17, '17 2:56pm  
I went to a doctor for a colonoscopy.  The insurance company assured me the procedure would be covered 100% since it's preventative.  Given the huge increase in premium, I don't have extra money.  Since it was covered 100%, I decided to have the test done.Now a second doctor, the doctor that interpreted the results, sent me a bill.  Foolishly, I paid it.  The doctor is out of network, so I get billed.If I had known the doctor was out of network, I would have asked for a referral to a truly in network doctor.  The insurance company advised me to reverse/dispute the charge and tell the doctor to submit the bill.  The out of network doctor (office staff) said she will not submit the bill.  Well, sister, then  you aren't getting paid.  The bank folks already reversed and disputed the charge. 4951
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cgm10sne1 Active Indicator LED Icon 10
~ 6 years ago   May 17, '17 3:06pm  
why wouldn't the office that ran the test let you know that the "interpreter of test" doctor was NOT in your network. That's insane to me....and why the hell would they remotely use a doctor to read the test who wasn't in your network. Scratching my head on this one. I don't blame you one bit for disputing this charge. Someone dropped the ball as far as informing you. 4951
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CC1974 Active Indicator LED Icon 8
~ 6 years ago   May 17, '17 3:40pm  
Where was this? 4951
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frebu Active Indicator LED Icon 3
~ 6 years ago   May 17, '17 3:43pm  
would they remotely use a doctor to read the test who wasn't in your network. Scratching my head on this one. I don't blame you one bit for disputing this charge. Someone dropped the ball as far as informing you.

@cgm10sne1: Welcome to Insurance/Medical services game? You would think that it would work like any other business, you hire one business who handles all the billing coming to you even if they contract out to a third party, instead everybody gets to send you a bill so you just have to assume the price you are paying is the right one because you had zero contact with the office sending you a bill. It is just another thing they have done to set up the medical field to be a money grab.
 
 
4951
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fcabanski Active Indicator LED Icon 16 OP 
~ 6 years ago   May 17, '17 4:57pm  
"why wouldn't the office that ran the test let you know that the "interpreter of test" doctor was NOT in your network."Two answers. 1 - the truthful answer.  Because then I'd go to a different doctor, and their fraud wouldn't work.  2 - the answer they gave me.  They claim to "always" tell patients.  I was very specific when I visited the office.  I asked, because with the high premiums I don't have a lot of money to spare.  I asked if the insurance would cover this 100%.  The insurance company said yes.  The person at the doctor office said "insurance covers preventative procedures 100%". 4951
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lola Active Indicator LED Icon 17
~ 6 years ago   May 17, '17 5:01pm  
It happens all the time. 4951
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mulmye Active Indicator LED Icon 5
~ 6 years ago   May 17, '17 5:12pm  
I went to a doctor for a colonoscopy.  The insurance company assured me the procedure would be covered 100% since it's preventative.  Given the huge increase in premium, I don't have extra money.  Since it was covered 100%, I decided to have the test done.Now a second doctor, the doctor that interpreted the results, sent me a bill.  Foolishly, I paid it.  The doctor is out of network, so I get billed.If I had known the doctor was out of network, I would have asked for a referral to a truly in network doctor.  The insurance company advised me to reverse/dispute the charge and tell the doctor to submit the bill.  The out of network doctor (office staff) said she will not submit the bill.  Well, sister, then  you aren't getting paid.  The bank folks already reversed and disputed the charge.
@fcabanski: That is not insurance fraud.  That term refers to the fraudulent attempt to receive services intending that payment be made by an insurance company not legally responsible.  That type of thievery of raises everyone else's premiums.  
 
 
4951
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fcabanski Active Indicator LED Icon 16 OP 
~ 6 years ago   May 17, '17 5:33pm  
You're right, it's medical billing fraud.The old saying is there's a sucker born every minute.  I wasn't born that minute. 4951
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teatime Active Indicator LED Icon 7
~ 6 years ago   May 17, '17 5:34pm  
4951
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fcabanski Active Indicator LED Icon 16 OP 
~ 6 years ago   May 17, '17 7:06pm  
We have to fight.  I will fight.Like I told the lady at the first doctor's office after she said "Obamacare has made things tough", they're tough for me.  My premium rose from $97 per month to almost $600 per month.  My deductible has tripled.  My out of pocket limit has doubled.I have to know the costs of things before I buy them or have them done.I'm being nice.  In reality, it's clear they set up their practice like this in order to circumvent insurance caps. 4951
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dotti573 Active Indicator LED Icon 15
~ 6 years ago   May 17, '17 8:06pm  
I am dealing with an issue not.  I had an ultrasound and paid 373 bucks.  The insurance covered it in full and now I am fighting with the hospitals billing department to return my money.  They took it in 3 seconds but are telling me it will take 30 days.  I had the insurance company call them and they cut it down to 14 days but I haven't seen anything yet.  I had the procedure on 4-27 and they were paid on 5-3.  I called them the first day.In another incident in NJ I went to a hospital that was in network and accepted my insurance.  I had to have emergency gallbladder removal at 9:30 at night and used the doctor on call.  He came in my room and swore up and down that he was in network.  I figured since the hospital was the on call doctor would be. I was wrong.  He was out of network.  I paid my co-pays and stuff and then moved to TX.  I got a call from his office asking if I would sign paperwork to give them permission to fight the insurance to get more money than what they got paid.  Told them they were on their own and I wasn't signing anything.  He shouldn't have lied.  They were looking for almost $15K besides what I paid and the insurance.  Never heard from them again. 4951
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mulmye Active Indicator LED Icon 5
~ 6 years ago   May 17, '17 8:18pm  
We have to fight.  I will fight.Like I told the lady at the first doctor's office after she said "Obamacare has made things tough", they're tough for me.  My premium rose from $97 per month to almost $600 per month.  My deductible has tripled.  My out of pocket limit has doubled.I have to know the costs of things before I buy them or have them done.I'm being nice.  In reality, it's clear they set up their practice like this in order to circumvent insurance caps.
@fcabanski: There are no "insurance caps."  Why not accept your responsibility as a consumer?
 
 
4951
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Basic Active Indicator LED Icon
~ 6 years ago   May 17, '17 8:29pm  
I work for a Doctor that is on-call at Kingwood HospitalIf we didn't accept pts. insur. We wouldn't bill pt. He would keep seeing the pts in the Hospital and 1 f/u office visit then we will send to a Doctor  in their networkHe cares about his pts. 4951
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fcabanski Active Indicator LED Icon 16 OP 
~ 6 years ago   May 17, '17 9:11pm  
"There are no "insurance caps."  Why not accept your responsibility as a consumer?"There are insurance caps for an in network provider.  The insurance company negotiates prices for procedures.My responsibility as a consumer is to pay what I agree before accepting a service.  I pay nearly $600 a month for health insurance.  Prior to the procedure both the insurance company and doctor's staff told me the procedure was fully covered by the insurance.  When I left the office, I made sure again - "are you sure this is fully covered?"  They said yes, there will be no bill.Then I received a bill.  The doctor has his practice set up with two offices.  One is in the network, the other is not.  The doctor sends tests to the out of network office for "interpretation".  Why?  Because the insurance will only pay a certain amount.  The doctor wants to charge more than the insurance pays.  So he essentially puts out a sign - I work with your insurance company and their billing rates - to attract customers.  Then he hits the customers with the charges a month after the procedure.It would be like buying something at the store, then receiving a bill for the additional charge that wasn't listed on the item or on the shelf. 4951
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Stealth83 Active Indicator LED Icon 16
~ 6 years ago   May 17, '17 9:22pm  
Removed By Request 4951
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mulmye Active Indicator LED Icon 5
~ 6 years ago   May 17, '17 9:41pm  
"There are no "insurance caps."  Why not accept your responsibility as a consumer?"There are insurance caps for an in network provider.  The insurance company negotiates prices for procedures.My responsibility as a consumer is to pay what I agree before accepting a service.  I pay nearly $600 a month for health insurance.  Prior to the procedure both the insurance company and doctor's staff told me the procedure was fully covered by the insurance.  When I left the office, I made sure again - "are you sure this is fully covered?"  They said yes, there will be no bill.Then I received a bill.  The doctor has his practice set up with two offices.  One is in the network, the other is not.  The doctor sends tests to the out of network office for "interpretation".  Why?  Because the insurance will only pay a certain amount.  The doctor wants to charge more than the insurance pays.  So he essentially puts out a sign - I work with your insurance company and their billing rates - to attract customers.  Then he hits the customers with the charges a month after the procedure.It would be like buying something at the store, then receiving a bill for the additional charge that wasn't listed on the item or on the shelf.
@fcabanski: YOU have no cap, only a failure to verify that the services of a service provider are covered.  What you pay in premiums is irrelevant.   The very language you are utilizing shows you are uninformed.  Your insurance company negotiates a fee structure with providers, not you.  The provider you went to was bound by that agreement for the services you received by that provider.  It was your responsibility to make sure the "interpretation" was done by a network provider.  Those have been the rules since I can recall.   You were at best cavalier in that duty.  You may claim from your doctor the responsibility for the interpreter's fees is his/hers for misinforming you but false accusations of thievery are not justified nor helpful.
 
 
4951
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