In 2017 it is more important than ever to double check your medical bills after procedures and hospitalizations. A 2014 TransUnion Health Care survey showed that 54% of people are confused by their medical bills and 62% are confused by out of pocket costs. A growing number of people are being ripped off at the doctor, whether that is happening intentionally or unintentionally is up for debate. This post will give you tips to prevent insurance fraud and avoid getting ripped off when you go to the doctor’s office.
What is insurance fraud?
At a high level, insurance fraud is when someone provides false information to an insurance company to receive a higher payout. In the healthcare sector, it often happens with inflated billing. That means charging for exams or procedures that never happened or miscoding exams and procedures. Each procedure and exam at the doctor’s office, ER, and the hospital has a specific code and is billed differently. For example, a visit to your general practitioner (GP) is going to be billed and charged differently than a visit to a specialist, like a Dermatologist.
Can I be a victim of fraud?
The short answer is yes, anyone who visits the doctor can be a victim. In fact, it is a fairly common occurrence. Under the Affordable Care Act (Obamacare) several exams and procedures are covered under Preventive Care. This means that when billed correctly, your insurance will cover the procedures and exams completely and you won’t have to pay out of pocket.
It happened to me
Last year I went in for a routine Well Woman visit and my doctor performed a routine exam and Pap Smear. A month later I received a bill for a few hundred dollars for the exam and test. I was wrongly charged for these procedures and they should have been covered in full by my insurance, without me having to pay a copay.
After I received the bill I called my insurance company and explained the situation and they agreed that the bill should be covered under preventive care. Unfortunately, I had to take matters into my own hands and call the doctor’s office and again explain the situation, that I was misbilled. The doctor’s office had agreed that they had miscoded my visit and procedure. The billing assistant edited the bill and resubmitted it to my insurance company. This is where I hoped the story would end.Unfortunately, I wasn’t that lucky. My insurance company received the bill again however instead of editing a past bill, the insurance company thought the doctor’s office was trying to submit the exact bill again. The insurance company didn’t realize that it was indeed a new bill with the new codes. So, my insurance company ended up denying that bill and again I was billed by my doctor’s office for the balance of a few hundred dollars. I had to call the doctor’s office again as well as my insurance company to get this taken care of. Unfortunately, it ended up taking 6 months to ultimately have my insurance company except for the newly coded bill.
Unfortunately, I wasn’t that lucky. My insurance company received the bill again however instead of editing a past bill, the insurance company thought the doctor’s office was trying to submit the exact bill again. The insurance company didn’t realize that it was indeed a new bill with the new codes. So, my insurance company ended up denying that bill and again I was billed by my doctor’s office for the balance of a few hundred dollars. I had to call the doctor’s office again as well as my insurance company to get this taken care of. Unfortunately, it ended up taking 6 months to ultimately have my insurance company except for the newly coded bill.
Key takeaways
The first step towards protecting yourself against insurance fraud is making sure that you understand your insurance coverage and plan. When you understand your plan you’ll know what’s covered and what’s not covered especially when it comes to preventative care. So, take the time to read through your insurance documents and be sure to ask your HR specialist at work if you have questions on what’s covered and what’s not. You can also call your insurance company, from my experience their customer service team is usually pretty helpful and from what I found and will answer thoroughly your questions regarding your plan.
The next step is to make sure you review all of your bills from the doctor to ensure that your being charged properly and things are being properly coded. It only takes a few minutes to pick up the phone and call your doctor’s office to ask them a question if something looks off to you. The small amount of time you take to learn and understand your coverage and bills could end up saving you hundreds, if not thousands of dollars throughout your lifetime.