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      01-24-2012, 11:47 AM   #1
Rallo
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Angry Health Care Fraud...

Went for a free routine health screening for work back in Nov and got a claim yesterday from health care provider that I owe $2,228.13...wtf?!
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      01-24-2012, 12:00 PM   #2
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Quote:
Originally Posted by Rallo View Post
Went for a free routine health screening for work back in Nov and got a claim yesterday from health care provider that I owe $2,228.13...wtf?!
We need more information....

BTW...you received the services that you are being billed for...not exactly "fraud" in my book....

It sounds like some of the services that you received were not "covered benefits" by your insurance....
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      01-24-2012, 12:01 PM   #3
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Contact your employer.
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      01-24-2012, 12:12 PM   #4
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      01-24-2012, 12:13 PM   #5
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If you went for work, contact your employer. Are you sure its a bill and not just an EOB explaining what was done and what the charge would have been?
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      01-24-2012, 12:28 PM   #6
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Quote:
Originally Posted by ideliver View Post
We need more information....

BTW...you received the services that you are being billed for...not exactly "fraud" in my book....

It sounds like some of the services that you received were not "covered benefits" by your insurance....
Haha, Right!!

I went in for a CT that my Dr prescribed. It was for a possible kidney stone so not a crucial scan. I asked the place if it was covered by my insurance and what if any copay there would be. They told me it was 100% covered.

2 months later i got a bill for $500 copay which is not listed as a copay by my INS. Called them, explained what happened. No more bill. Underhanded, maybe. Mistake, likely. Fraud, no.
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      01-24-2012, 12:33 PM   #7
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It's an EOB but it states I owe $2,228.13. The total was $2,341.00. I'm checking with my healthcare provider since I received the EOB from them. All of the amounts on the claim just show "Laboratory" for type of service. I specifically stated to them that this was for a health screening for work and handed them a form from my healthcare provider that has physician instructions that say this is, "to be covered at no cost to the participant."
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      01-24-2012, 12:50 PM   #8
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did you go to a provider in your health insurance network?
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      01-24-2012, 02:25 PM   #9
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Quote:
Originally Posted by mdyaman View Post
did you go to a provider in your health insurance network?
If its a healthscreen for work, usually the employer will tell you where you can go. As long as you go to one of the listed providers it should be covered by your employer.
This is the field I have worked in for 10+ years. If you have an HMO and the service was not requested by primary doc, the service will be denied by "your insurance" since it was not a pre authed service. The employer requested these services so it should be billed to them not your insurance carrier, that is where the mix up most likely lies. Contact your employer and let them know you are getting billed for this.
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      01-24-2012, 02:26 PM   #10
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Quote:
Originally Posted by Rallo View Post
It's an EOB but it states I owe $2,228.13. The total was $2,341.00. I'm checking with my healthcare provider since I received the EOB from them. All of the amounts on the claim just show "Laboratory" for type of service. I specifically stated to them that this was for a health screening for work and handed them a form from my healthcare provider that has physician instructions that say this is, "to be covered at no cost to the participant."
The EOB comes from the insurance company and is not a bill. It is just an explanation of the actual bill that you can expect to get and what you can expect to pay.

If this was a pre-employment physical, it seems that your employer should have been billed directly and never submitted to the insurance carrier.

Again, a clerical error and clearly not FRAUD like you stated.
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      01-24-2012, 02:31 PM   #11
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Quote:
Originally Posted by MP0WER View Post
Haha, Right!!

I went in for a CT that my Dr prescribed. It was for a possible kidney stone so not a crucial scan. I asked the place if it was covered by my insurance and what if any copay there would be. They told me it was 100% covered.

2 months later i got a bill for $500 copay which is not listed as a copay by my INS. Called them, explained what happened. No more bill. Underhanded, maybe. Mistake, likely. Fraud, no.
So you expect the clerk making $8.00 with a highschool degree to know your insurance benefits better than you do?

Do you alsdo expect the person that takes your appointment at the body repair shop to understand your auto insurance deductible and who was at fault when you take you car in for repair after an accident?

I'm just saying....

Fraud is being intentionally billed for services that were never received...and it happens
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      01-24-2012, 02:43 PM   #12
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I just went through 6 months of multiple doctors, X-Rays, MRI's, CT scans and bone scans to figure out what wat wrong with my leg. In the middle of the whole ordeal i changed jobs, so new insurance info... You have no idea how many hours I had to spend on a phone with billing departments, office managers and other confused individuals to get everything straightened out... and i still get all kinds of bills for shit I am not supposed to be paying for.
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      01-24-2012, 02:50 PM   #13
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Rule #1 Bill first...
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      01-24-2012, 04:13 PM   #14
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If it's an EOB, I wouldn't sweat it. Make sure you received all the services they are billing your insurer, and then forget about it (until you receive an ACTUAL bill).

Yes, CT scans are expensive, but expect the price to be cut in half if you went to an in-network provider. The only people who pay full price for medical services are those who can't afford it, and aren't savvy enough to question it. Healthcare is jacked up in this country.
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      01-25-2012, 11:05 AM   #15
Rallo
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Thanks for the constructive advice guys. I'm thinking there had to be "extra" tests done to get to that high of an amount for a supposed free health screening for the job. Health care provider says the blood work was sent to get done out of network by doc so they have it listed as such. They are resubmitting it to in network and am told to wait for a new EOB. We'll see what the 2k goes down to.
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      01-25-2012, 11:29 AM   #16
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What happens if you don't pay?
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      01-25-2012, 12:22 PM   #17
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What happens if you don't pay?
Goes to collections, then on your credit. It's like anything else you buy on credit but don't pay for.

Hopefully, you'll all pay REALLY close attention to what your doctor tells you to do, and ask how much it costs. I signed up for the High Deductible Health Plan this year, and I PROMISE you, when you are paying for the first $3000 of medical bills, you ask alot of questions.
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      01-25-2012, 12:51 PM   #18
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Quote:
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Hopefully, you'll all pay REALLY close attention to what your doctor tells you to do, and ask how much it costs. I signed up for the High Deductible Health Plan this year, and I PROMISE you, when you are paying for the first $3000 of medical bills, you ask alot of questions.
This is the best solution to fight medical inflation...I have a $5,000 deductible/individual.

I insure my family of 5 for $480/mo....compared with $1800 to $2000/mo for a $100 deductible
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      01-25-2012, 01:28 PM   #19
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Quote:
Originally Posted by ideliver View Post
This is the best solution to fight medical inflation...I have a $5,000 deductible/individual.

I insure my family of 5 for $480/mo....compared with $1800 to $2000/mo for a $100 deductible
That's crazy! I had no idea it cost that much.

I pay zero / month to an insurance company, but Mr. Taxman gets me every year so effectively I pay...I wonder how much I'm effectively paying per month in Canada...

You guys benefit from lower taxes though, so perhaps it all works out in the end.
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      01-25-2012, 01:29 PM   #20
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Quote:
Originally Posted by ideliver View Post
So you expect the clerk making $8.00 with a highschool degree to know your insurance benefits better than you do?

Do you alsdo expect the person that takes your appointment at the body repair shop to understand your auto insurance deductible and who was at fault when you take you car in for repair after an accident?

I'm just saying....

Fraud is being intentionally billed for services that were never received...and it happens
I think if you re-read my post you'll find that i was fully agreeing with you. Specifically the last line. The fist line was Right as in correct.
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      01-25-2012, 01:31 PM   #21
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Dad was paying $1500 for 4, so he did the same. Now we don't go to the doc as often, and ask questions.
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      01-25-2012, 01:40 PM   #22
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Quote:
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This is the best solution to fight medical inflation...I have a $5,000 deductible/individual.

I insure my family of 5 for $480/mo....compared with $1800 to $2000/mo for a $100 deductible
You must be self employed.
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