cancel
Showing results for 
Search instead for 
Did you mean: 

Wow and I thought Insurance Companies were bad....

Highlighted
Established Contributor

Wow and I thought Insurance Companies were bad....

Got bill from DH doctors office....they billed our insurance for over $600.00 worth of services that were not provided. When I called the nurse argued with me that he had those things done including a ultrasound....HELLO I was there!!!! And I am a nurse so it is not like I don't know what he had done. I am ticked because they want my 20% that I owe and I am not going to pay it. Can we say INSURANCE FRAUD? Geez I can't get a break. Hope they know I have a kid with massive medical bills and I have been around the block a few times, I have seen it all. Triple billing, etc. Well I guess I have vented enough now!!
Message 1 of 11
10 REPLIES 10
Highlighted
Moderator Emeritus

Re: Wow and I thought Insurance Companies were bad....

What services were provided and what exactly was billed? I work in healthcare and I know all too well the mistakes in billing.
Message 2 of 11
Highlighted
Moderator Emeritus

Re: Wow and I thought Insurance Companies were bad....

For the past many minutes, I was trying to find a local story here of a dentist who would bill insurance companies for work not performed. I remember the story featured several patients (all kids) who had their insurance billed for up to 10 cavities all in one sitting when the patient only had one. In a couple cases, the dentist did procedural work on a cavity that the patient never even needed. If I find this, I'll post it.


Message Edited by llecs on 08-13-2008 03:32 PM
Message 3 of 11
Highlighted
Established Contributor

Re: Wow and I thought Insurance Companies were bad....



@fused wrote:
What services were provided and what exactly was billed? I work in healthcare and I know all too well the mistakes in billing.



Only services provided were exam and cortisone shot...was charged for ultrasound, ultrasound placement and a 250.00 splint that was never received nor was anything said about one. When I questioned billing she said that one was prescribed and sort of acted like I was lying and then told me he DID have a ultrasound....bullhockey I was there!!!!!!
Message 4 of 11
Highlighted
Senior Contributor

Re: Wow and I thought Insurance Companies were bad....

Have you notified your insurance company of the fraud, yet?

I may not work in the healthcare field, but I DO know that insurance companies don't take kindly to fraud. Not one bit. We had to holler "fraud" a while back when we, too, were billed (and our insurance was billed, too) for an ultrasound that never happened.

Needless to say, our insurance company (BCBS-Fed) spanked them like there was no tomorrow.

I'd think even the THREAT of complaining to your insurance company should make things happen with the provider ... they stand to lose the entire contract with your insurance company ... at the very least.

That's what ended up happening in our situation. The HC provider in question lost a contract that cost them at least 3/4 of their patient pool. Not pretty.

Please consider it. Insurance companies have more time to devote to fraud and resolution than an individual -- especially one who already has two jobs (mom being one of them!).

Best of luck, Wildcat ... you'll be in our prayers that you emerge (and deservedly so) unscathed!!

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*

Hubby's FICOs when we started: high 400s (June 2008)
Hubby's FICO NOW (04/06/09): TU: 679 EQ: 608 EX: ???
My FICOs: TU: 643, EQ: 606
Closed on new home: 1/20/2009 -- If we can do it, YOU can do it!!

Message 5 of 11
Highlighted
Senior Contributor

Re: Wow and I thought Insurance Companies were bad....

Oh, and for whatever this is worth: the HC provider in question was found to have fraudulently billed numerous times.

After losing the BCBS contract (as "preferred provider"), they quickly went out of business.

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*

Hubby's FICOs when we started: high 400s (June 2008)
Hubby's FICO NOW (04/06/09): TU: 679 EQ: 608 EX: ???
My FICOs: TU: 643, EQ: 606
Closed on new home: 1/20/2009 -- If we can do it, YOU can do it!!

Message 6 of 11
Highlighted
Moderator Emerita

Re: Wow and I thought Insurance Companies were bad....

It's (insert unprintable noun here) like these that make healthcare costs even worse than they would be anyway.

The rule of coding (and it should be the rule of billing, too): if it isn't documented, it didn't happen. Period.

I say call up your insurance company and nail their butts to the wall.
* Credit is a wonderful servant, but a terrible master. * Who's the boss --you or your credit?
FICO's: EQ 781 - TU 793 - EX 779 (from PSECU) - Done credit hunting; having fun with credit gardening. - EQ 590 on 5/14/2007
Message 7 of 11
Highlighted
Regular Contributor

Re: Wow and I thought Insurance Companies were bad....

You think thats bad? My dad has about $30,000 total debt from about 15 different collection accounts all because of one kidney stone. I guess thats what happens when you don't have med insurance.

Starting Score: 702
Current Score: 728
Goal Score: 760


Take the FICO Fitness Challenge
Message 8 of 11
Highlighted
Senior Contributor

Re: Wow and I thought Insurance Companies were bad....

I had something *very similar* happen to DH.  I was there!!!!  I immediately phoned the ins. company and let them deal with it.
 
The charges were eventually dropped. 
Message 9 of 11
Highlighted
Frequent Contributor

Re: Wow and I thought Insurance Companies were bad....

It's scary how often these things happen. We have a regular patient at work with a chronic condition. She was seeing another chiropractor that also practiced acupuncture. The patient would come to our office for chiro, then see the other doctor for acupuncture.
 
One day, her visits to our office were being denied. I contacted her insurance company and was told that the patient was seeing another chiropractor. I explained that the other chiro was an acupuncturist, and the insurance rep told me that none of the charges from the other one were acupunture at all. All chiropractic codes which, of course, get paid more.
 
So, our patient was out of visits for the year because of the assumed insurance fraud by the other doctor. I always feel horrible in these cases, especially because it's the patient that loses.
 
Any updates, wildcat?
Message 10 of 11
Advertiser Disclosure: The offers that appear on this site are from third party advertisers from whom FICO receives compensation.