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Thread: i think my doc is frauding my insurance!HELP

  1. #1
    tampafldancer
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    Default i think my doc is frauding my insurance!HELP

    Well as many of you know i went down to miami to have a little work done.

    Up front he told me that my nose would cost 10k to do, 6k of that is non cosmetic. Then my brows would cost 6k.

    10k would be my cost if i used insurance (which i did) Otherwise it would cost 16k cash for the whole thing.

    My insurance calls me inquiring about a 32k bill in miami for my work done, after i already paid 10k cash upfront.

    i call my insurance and they tell me that is the hospital bill... around 26k or so and they were trying to get money from the insurance to cover the rest of the non cosmetic part. WHAT THE FUCK! THEN!!!! she tells me that they can pull out with the insurance company if i want to pay the rest of the 6k for what i had done?!!!!

    I asked why the difference between 6k cash for not using insurance and 32k for using insurance and she went back to telling me that most of the charge is university of miami's charge.

    what do i do? Should i get a lawyer? I think they are frauding my insurance company.
    These are damn good doctors too.. what the fuck over?

  2. #2
    Banned Melonie's Avatar
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    Default Re: i think my doc is frauding my insurance!HELP

    All hospitals try to offset the 'losses' that they are forced to incur by law when treating illegal aliens, medicaid patients, uninsured patients who later go bankrupt etc. - by 'overcharging' other patients ... and particularly by overcharging other patients' insurance companies. I doubt that your doctor has anything to do with the hospital's billing to the insurance company, other than perhaps acting as a messenger.

  3. #3
    Featured Member Hello_Kitty27's Avatar
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    Default Re: i think my doc is frauding my insurance!HELP

    Quote Originally Posted by Melonie
    All hospitals try to offset the 'losses' that they are forced to incur by law when treating illegal aliens, medicaid patients, uninsured patients who later go bankrupt etc. - by 'overcharging' other patients ... and particularly by overcharging other patients' insurance companies. I doubt that your doctor has anything to do with the hospital's billing to the insurance company, other than perhaps acting as a messenger.
    Melonie hit the nail on the head. This happens all the time. It's not only for reasons that Melonie mentioned, but also b/c insurance companies 'fight' a lot of bills and short-pay them, based on what they feel the standard cost for something should be. I have a friend in medical billing and she deals with this all freakin day.






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  4. #4
    Sitri
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    Default Re: i think my doc is frauding my insurance!HELP

    C.
    You do not have to get an attorney. The insurance company will have more than enough to go around. You just have to let claims know what procedure was performed and believe me, they will slice and dice U of M down to nothing.

    Don't sweat it, they are big boys and they know how to handle this. I was in health insurance for many years.

  5. #5
    Banned Melonie's Avatar
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    Default Re: i think my doc is frauding my insurance!HELP

    yes, and if you really want to get your money's worth, file for personal reimbursement of your surgeon's fee ! All they can do is say no, but if there was a 'medical reason' to work on your nose (restricted airway etc.) you may be able to get the insurance company to cough up a couple of thousand.

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    God/dess FrustratedBunny's Avatar
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    Default Re: i think my doc is frauding my insurance!HELP

    yep, if you have good insurance coverage they jack the cost up so they can get as much as they can. And then there are people who go into the hospital with no insurance and no money and need $25k worth of gallbladder surgery and never pay. And then your insurance company probably has some contracted rate or whatever with them. It's totally fucked up. I know I have gotten a cash-pay discount when I had no insurance and I've also had a bill reduced because I did have insurance. Who knows. But it's all insurance b.s. Don't worry about it.

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