Because it's ILLEGAL

[TryNotToBeThatOne]

This is in sightings because I heard about it but did not experience it myself.

Employee works tech support for scheduling software frequently used by clinics and doctors' offices. Let's call him E.
Caller is Office Admin in a Dr's office. Let's call her Bitch, abbreviated to B.

B: Yes, I'd like to know how to change the billing function to add interest.
E: I need a few more details, which part of the billing are you talking about?
B: I want to charge the insurance company for the interest on the money I would have gotten if I had depostied, when they don't pay in less than 30 days.
E: Let's me see if I have this straight. When a patient comes in, you send a bill to the insurance company, the company pays you, according to the contract that you have both signed. If they take more than 30 days you want to add interest to the bill? Based on if you had had that money deposited already?
B: Yes, now how do I do that?
E: You can't. It's illegal and the program won't do it.
B: But they owe us that money. When they don't pay quickly, we're losing money.
E: Ma'am, charging them interest violates the contract that you have with them. If you want to charge them interest you're going to need a new contract with that included. Until then, it's Ee-lee-gall.

Lather, rinse, repeat. A two-minute call took 20 because she could/would not get it through her head that what she wanted was illegal and thus E & his company were not going to help her do it.

[IT Grunt]

Pfft... illegal shouldn't be a showstopper, come on.

Doctor's offices can get like that when they think they're 'losing money'. I recall one time I had to take my wife to the emergency room. The insurance paid the emergency room bill, but then we get a bill from the doctor's office who looked at her that night for another $143.



They were in network, there shouldn't have been any extra cost. What they were doing was balance billing us for what the insurance company didn't pay, /according to the contract they signed/. That's the cost they were supposed to write off. When confronted by the insurance company, they claimed they didn't have a contract, despite the fact that the insurance company's records quite clearly showed that yes, in fact, they did. In the end, the insurance company ended up paying it instead of us so they'd get off our backs, and dealt with them behind the scenes.

[PuckishOne]

Oh, geez...where are these Johnny-on-the-spot people when I'm calling trying to find out why claims were never submitted in the first place? It's no longer surprising to me how many providers have no clue about their contractual obligations - we see people who get billed for the write-off amounts all the time. I've found that a quick phone call to the provider and mention of the words "insurance fraud" work fairly well most of the time but it's really sad that this is what's required.

[marasbaras]

It's not illegal. It's just against the contract. It's a civil matter.

And, I can see her point-of-view. Insurance companies are the WORST. They refuse to pay, pay late, deny claims, etc.

[Broomjockey]

It's not illegal. It's just against the contract. It's a civil matter.

Last I checked, fraud was still a crime, no? Insurance fraud in all its forms is probably the most common form of fraud, too. So, no. Not a civil matter.

[Geek King]

Last I checked, fraud was still a crime, no? Insurance fraud in all its forms is probably the most common form of fraud, too. So, no. Not a civil matter.

Um...what was described wasn't insurance fraud, it was trying to change/renegotiate a contract before its expiration. If all parties on the contract do not agree to the change, it can not be enforced. Insurance fraud involves submitting false claims to an insurance company (ie., the doctors making up fake patients for Medicare fraud they caught last year). At worst, this might have been a really inept attempt at contract fraud.

[PuckishOne]

What that doctor's office was attempting to do constitutes an illegal billing practice that is proscribed by the terms of their contract with the insurer. They entered into a contract with the insurer that states "you shall receive $X for procedure A," and trying to bill for any more than that $X is an attempt to defraud. A contract is a legal document, and anything that is done in violation of its terms is, by definition, illegal.

I deal with this all the time and, although there is a metric crapload of laws dealing with this sort of thing, it's disgusting how often it's attempted.

[Broomjockey]

Um...what was described wasn't insurance fraud

I was responding to Puck mention of insurance fraud/ marasbaras's statement of it being a civil matter. I may have misapplied the statements, as in marasbaras may not have been responding to puck's comment (I've only realized), but to the OP. As well, there's apparently a wide gap between Canadian and US law on this matter, as fraud can be punished with up to 10 years in jail, but there doesn't appear to be a corresponding criminal charge in the US. So, what I said was correct, from how the statements were organized, and from my national point of view.

[Geek King]

[et. al.]

Fair enough. I missed the Canada connection.

If you're in SW Ohio, PM me and I'll grill up some burgers and Bratwurst in apology.

[Kelshir]

Overbilling?

Um...what was described wasn't insurance fraud, it was trying to change/renegotiate a contract before its expiration. If all parties on the contract do not agree to the change, it can not be enforced. Insurance fraud involves submitting false claims to an insurance company (ie., the doctors making up fake patients for Medicare fraud they caught last year). At worst, this might have been a really inept attempt at contract fraud.

I might be wrong, but it might be classified as over billing which is insurance fraud. Plus in some states it is illegal to charge interest for any medical debt, varies state to state.