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 Posted: Wed Oct 29, 2008 11:01 pm Post subject: if a physician bills your |
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| if a physician bills your insurance company that is not in your records is that fraud? |
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trina
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| Posted: Wed Oct 29, 2008 11:05 pm Post subject: |
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| What do you mean by "not in your records"? Did the physician provide medical treatment? If so, they can send the bill to who ever they want... even me (as long as they don't violate any privacy laws). The physician has a right to seek payment for the bill. I don't know of any laws that limits who he can send the bill to in order to be paid. That is, it's not unreasonable that the bill would be sent to an insurance company. Where would the fraud be found? |
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tcope
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| Posted: Wed Oct 29, 2008 11:23 pm Post subject: |
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| Actually isn;t the insurance company the first place a doctors office would send billing..unless you had not had insurance..then it would go directly to you. |
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fireyone
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| Posted: Thu Oct 30, 2008 12:40 am Post subject: |
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Ummm..how did they know who your insurance company was? Their name might not have been in your "records" (I don't know what you mean by records) but they found out who it was somehow.
Could you or someone else have told them? Shown them an insurance card?
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LifeIsGood
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| Posted: Thu Oct 30, 2008 12:47 am Post subject: |
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| Sounds like a reasonable assumption to me. |
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fireyone
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| Posted: Thu Oct 30, 2008 5:52 am Post subject: |
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If you have used the service of a physician from the network then he/she can send the bills for recovery from the insurance company. Once the payment is made the report of the claim will then appear in the record of the insurance company as well as in your CLUE report.
If you want to keep the report away from the record arrange to pay for the bills out-of-pocket.
| Quote: | | Could you or someone else have told them? Shown them an insurance card? |
Yeah Life, in all probability she have used the insurance detail while availing the service. |
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simon
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| Posted: Thu Oct 30, 2008 9:06 pm Post subject: |
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| Out of pocket can get expensive really fast. |
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fireyone
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| Posted: Fri Oct 31, 2008 3:28 am Post subject: |
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That is why they have all that coverage available so you don't have all that out of pocket. The best thing to do is to take the time to understand the insurance that you have.
I got this lesson hard and fast from a provider when they were sending me thousand dollar bills for items that should have been billed a billable expense on my coverage.
The best way to cover you butt is to know what coverage you have and make sure that your insurance company is only letting the provider bill with the service provided. I used go on my insurance website and monitor the billing to make sure that I was not liable.
I had one claim that had three days till billing time frame was up, they got lazy and did not submit to the insurance company, then decided it was easy to pop a bill in an envelope to bill me. I DON"T THINK SO. Needless to say, they heard from me and the insurance company told me that they would back me on it. |
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goodnatured
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| Posted: Sat Nov 01, 2008 1:15 am Post subject: |
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Most health insurance companies and sometimes employers will give you abook on what your plan is and the different things they cover. Whe n my hubby got his new job a few years ago we walked out of the office with tons of booklets on all the services covered by the company. It included deductibles that would apply and co-payment charges. Highmark BC/BS also sent is in the mail a big book of the providers that were in net work. It is a guide book that I have used frequently before scheduling any appointments.
It lalso has a website as GN mentioned on your benenfits. You can veiw your whole plan and every claim they have paid on your behalf. I also had a place that got lazy on billing and didn't turn in the claim form until 6 months after the service was billed. I called the office and they said it would be removed. I beleived that they in good faith would do this but a year later when veiwing my credit report seen they in fact had not. I never got another bill but they sure marked my record. It took disputing before the mark was removed.
It is best to always check , if possible, to be sure a bill was paid. It happens a lot and paople do make mistakes but for your own good just take a few minutes and check. |
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fireyone
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| Posted: Sat Nov 01, 2008 3:18 am Post subject: insurance |
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| Yea.....I've heard of 'this' kind of thing happening ALOT with the 'clients' that I help ( I work with the Elderely). They may THINK they have this ot that covered, when, in fact, they don't. KNOW they have to pay out of pocket with the very little money they DO have. |
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sdchargersfan
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| Posted: Sat Nov 01, 2008 11:52 pm Post subject: |
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| Thats really sad to hear. You would think that their family members would step in and try to make sure the coverage was there. I agree our senior citizens reall do not have much money and just one cost of something that health insurance didn't pay could take almost or all their check for one month. |
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fireyone
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| Posted: Thu Nov 06, 2008 2:33 am Post subject: |
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| I have dealt with a few older veterans, I have found that veterans administration to take care of these veterans. They may have to pay for the car if they were not in a wartime situation, it is not very cheap but it does cover everyt5hing. |
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goodnatured
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| Posted: Thu Nov 06, 2008 8:53 pm Post subject: |
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| Thats not really fair what they do with the medical. All the veterans should have free medical as long as they served. Sometimes I think are country got all their standards mixed up. Just like the elderly and property taxes...thats another story though. |
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fireyone
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| Posted: Sat Nov 08, 2008 10:49 pm Post subject: |
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| Sometimes with the veterans it is an issue that they are not near a va hospital, they have been setting up the clinics in outlying areas, we raised $10,000 to buy a van from the DAV, this fundraising has to happen about every five years or so. These vans are used daily. |
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goodnatured
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| Posted: Sun Nov 09, 2008 12:26 am Post subject: |
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| I like the idea as a whole though. you think government could chip in some omoney to help with this along with the fundraising |
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fireyone
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