These are hundreds of dollars that are coming out of retirees pockets!

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PostPosted: Thu May 01, 2008 4:48 am   Post subject:   

In descussion with people involved in the EMS, it has been brought to my attention that on medical transports that involves inter-facility medical transports, some hospitals that are affiliated with other larger hospital are bypassing the closest appropriate facility that could handle the procedures that needed to be preformed are sending people that are on Medicare to their affiliate.



Therefore, the Pt has to be informed that a NEMB (Need For Exclusion of Medicare Benefits) form has to be made aware to the Pt. This form explains to the pt that the difference in the mileage to the closest appropriate facilty to the affiliate hosp will be the resposibility of the pt.



These are hundreds of dollars that are coming out of retirees pockets!

The majority of the time the pt was not even given the option or even know that they have a say so in their destination choice. The NEMB form does not come into to play until the EMS service has already been scheduled for the transport and shows up at the discharging facility and they have to explain to the pt and receive the signature saying that they will assume responsibilty for the difference in payment.



This in their oppinion is a very poor inconveinience to the Pt, being transported more miles (50 or more) and a very unnecessary expense from people that can't afford this charge. This could be as much as $10 an additional mile on top of a base price for ambulance services.



This to me is hospital systems intentionally bilking seniors.

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PostPosted: Sun Apr 05, 2009 12:25 pm   Post subject:   

I dont know if this is considered as a fraud or what. I have encounter a situation wherein the doctor offers me a service that is not covered in the insurance but he will charged it to the insurance. I need to place a signature in a waiver declaring that a particular service has been done by him but in fact it doesnt. In exchange, i will receive his service with nothing to pay at all. I view this case as a win-win situation between me and the doctor. Whats your idea bout it?

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PostPosted: Thu Aug 06, 2009 10:21 am   Post subject: mammogram fraud  

Being a 50 something woman I have had more than a few mammograms in my life. The common practice was after taking the necessary pictures I was told to wait a few minutes so that the pictures could be redone immediately if they were not "good" pictures. Then I would either redo the pictures or be dismissed. I just went last week to get a mammogram and they immediately dismissed me on my merry way, no wait time. So now I have to go back a second time to have the mammogram redone because the first shot wasn't good enough. Do you think this new way of dismissing patients before looking at the results and them having them come back to do a second mammogram the next week is costing the insurance company twice as much as the old way of keeping the patient a few minutes before dismissing to ensure the pictures came out okay? Is this some sort of insurance fraud?


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PostPosted: Thu Aug 06, 2009 10:42 am   Post subject:   

Quote:
I view this case as a win-win situation between me and the doctor. Whats your idea bout it?
It's fraud pure and simple...Out of curiosity, what is the service you are receiving and what is the doc SAYING he's doing?
Quote:
Do you think this new way of dismissing patients before looking at the results and them having them come back to do a second mammogram the next week is costing the insurance company twice as much as the old way of keeping the patient a few minutes before dismissing to ensure the pictures came out okay?
I doubt it, I'd think it costs the same, because they are doing the same pics both times..this is soooooo irritating, I've personally never had a mammogram that didn't have to be done again, or after reading it, I have to proceed to a sonogram, breast mri, or something else...
Quote:
Is this some sort of insurance fraud?
No, not at all..


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