Wow, upcoding

[mathmajor]

Now that I've hit my deductible I've just decided to let it go. Only paying 10% now so I'm pulling out all the stops - therapy, psychiatry, chiropractor. Why not?

Also, paid my $1500 with an HSA from two jobs ago

[Marian]

I reported a claim to my health insurer / employer for fraud. The bill was hand written, the letterhead and return envelope had white-out over the name of a non-medical company (I believe it was a construction company). The doctor would not accept credit card / debit card / HSA card, only a personal check. A bit of internet search reveled the doctor's son worked at the construction company, and they had the same name, only Sr and Jr. I had never met this doctor, had never heard of this doctor, he was retired, and apparently had been in the room when I had an outpatient procedure and was "out". The bill was for an outrageous sum, with no insurance discount, because he was "out-of-network". You betcha I reported this a fraud. The insurance company reduced my out-of-pocket cost to the in-network fee, but that's it. He still received more in compensation than the actual doctor.

[mathmajor]

That's silly. Not just fraud but more or less criminal.

[Woodrow]

Do you know any local District Attorneys?

[WhosOnFirst]

Originally Posted by mathmajor

That's silly. Not just fraud but more or less criminal.

I agree. I'd submit the documentation that you have to your state DOI and ask that they investigate this "doctor". I'm surprised your carrier didn't investigate for fraud. Although, they may have paid it to meet regulatory prompt payment requirements and plan on recovering the money after an investigation is completed.

After being in this industry for as long as I have, I am of the opinion that any claim submitted on an improper claim form should be denied. I have only seen one example of a legitimate claim that was a receipt similar to what is described above (without the whiteout and other fraud stuff). That claim was for adoption fees where the state mandated that adoption fees be covered like maternity claims.

[msuMATH2013]

I am legitimately embarrassed to be an analyst for health consulting firm and be charged for an OV instead of annual wellness.

I don't know how much clearer I could have been when I said "I am new to the area and don't have a PCP. I want to schedule an annual wellness exam."

Life pro tip, literally don't mention anything else at a wellness exam or during scheduling. I mentioned my shoulder hurts when scheduling the visit. They didn't even perform a wellness exam... $140 coinsurance later and I still haven't had a wellness exam. I was none the wiser during the visit, either. I can see how it happens to regular people all the time.

[<12parsecs]

It's pretty frustrating. I think if someone has a wellness exam scheduled, there should be some statement on the medical provider's part that anything outside of the wellness exam will be billed additionally for. My kid's pediatrician doesn't bill extra for asking little things outside the wellness exam, but it seems like additional billing in adult care is common. I thought there was a certain amount of extra time they had to spend outside of the normal wellness portion of the visit for it to be billable as additional, but those rules might have changed.

[Don Quijote]

Doc: how are you today?
skeptic: if I say anything, are you going to charge me for it?