Don't try to commit fraud and then come beg for money from me...

[Raveni]

I wonder why the efficacy and brains of the admin/financial staff of a medical facility seems to be inversely proportioned to the medical care?

There is a great walk-in clinic near my home that has short waits, excellent service, and is covered by my insurance.

Their corporate billing office is staffed by idiots or fraudsters... I don't think it's both.

Several times, I've had to have this exact same conversation with their Billing Specialist. They must be on a script, so it works every time, at the exact same point of the conversation.

BS - I'm calling about the bill for the service on <date> at <BS Location>.
Me - I had service on <date>, but it was at <clinic> and my insurance already paid it.
BS - Yes, since your insurance denied this claim, you are responsible for the payment of this bill.
Me - But you double-billed the insurance by "mistake", so they only paid it once. I only had one flu shot on that day.
BS - Our records show that you had a flu shot at <BS Location> on <date>.
Me - Google Maps says that's the address of a call center. I assume that's where you are right now. Look around, do you even have a clinic there?
BS - ...
Me - ...
BS - Oh, I see the problem. Your insurance company made an error, but we can correct it on our side. Thank you so much for your cooperation. <click>


FYI, this results in them changing the service location on their second bill to the clinic location, and submitting it to my insurance company for the 3rd time. This gets denied again, but my insurance company will at least reference the bill that was already paid, so then they stop bugging me about it. I always get 3 explanation of benefits at the end of the month for everything we do:

1 - Paid
2 - Denied, not in network (because it's their admin office / call center)
3 - Denied, already paid, see #1

[PepperElf]

can they try to send the bill to collections, or is that enough paperwork to prove that you don't owe them anything?

[blas]

I am more suspicious than ever of that kind of thing when a clinic visit of mine from December 2011 was "accidentally" never filed properly to insurance, and I fought for a year to get it so I didn't have to pay it in full.

[Headset Hellion]

I had a similar problem with an urgent care clinic here. I went in for a physical, not knowing that visits to an urgent care facility for a non-urgent reason are not covered by my plan.

They billed my insurance and the claim was denied. After the first claim was denied, they changed the coding and resubmitted it, which I'm pretty sure is fraudulent. I had paid a co-pay at the clinic and that amount was not reflected on the bill they sent my insurance. They also billed my insurance about FOUR TIMES what they would have charged me out-of-pocket! Apparently when they thought that my insurance would cover the visit, they figured they would make some extra money out of the deal.

So I called my insurance company and we had a nice little conference call with the billing department for the clinic, during which I sweetly said, "I'm sure there's been some mistake. It looks like there's been a clerical error on my bill, because when I called the clinic I was informed that a physical exam only costs $XX." She apologized profusely and promised to fix my bill, which oddly enough I still have not received almost a month later...

[taxguykarl]

Check your credit. This may well not be the last your hear about this nonsense, Raveni.

[Raveni]

Oh, this isn't the last time they will probably do this, but it's never been referred to collections or worse. I check my credit every year. Or rather, my wife does.

[sms001]

Have you tipped your insurer to this nonsense Raveni? Sounds kinda scammy to me too - I imagine people cough up in between steps 1 and 2 every once in a while. Glad you're on the ball about it, but I bet a lot of people aren't.

[taxguykarl]

I imagine people cough up in between steps 1 and 2 every once in a while. Glad you're on the ball about it, but I bet a lot of people aren't.

Especially if it is a small amount in question.

[Hermione]

They billed my insurance and the claim was denied. After the first claim was denied, they changed the coding and resubmitted it, which I'm pretty sure is fraudulent....

Not at all fraudulent. A lot of times the diagnoses just need to be re-sequenced or I have to add a prefix in front of something or a modifier because that's why it got denied. As a matter of fact, I resequenced diagnoses on a denied claim just this week. Or the insurance may not pay for that diagnosis so I need to look at the note from the visit again and find another one.

[barainga]

I suspect idiots working for fraudsters.

[Sandman]

Not at all fraudulent. A lot of times the diagnoses just need to be re-sequenced or I have to add a prefix in front of something or a modifier because that's why it got denied. As a matter of fact, I resequenced diagnoses on a denied claim just this week. Or the insurance may not pay for that diagnosis so I need to look at the note from the visit again and find another one.

Had that happen to me. Doc ordered routine blood and urine tests for my physical. For some reason the lab billed it as illness. I called my insurance company, which agreed with my logic (Doc ordered the tests BEFORE the physical... not after, hence for my physical which should be 100% covered). Insurance company told me EXACTLY what to do to make sure I wouldn't have to pay for anything more than I should have to pay.