Reverse Insurance Fraud

[levittownnick]

I have Blue Cross Blue Shield of North Carolina and I believe that they practice fraud in that they routinely deny claims that they will later approve if the patient files an appeal. The deal goes like this: You have a "procedure" in a doctors office that requires anesthesia. The doctor is "in network" but the anesthesiologist is not. You get charged for "out of network" coverage which leaves you with a big co-pay. You can appeal the decision because there is no choice of anesthesiologist but you have an "in network" MD. When you appeal, they acknowledge the "no choice" and credit the difference. They knew all along but know that not every-one is savvy enough to challenge them. They steal from those that can least afford it.

Why don't some law enforcement agency put a stop to this?

 

[tommays]

Re: Reverse Insurance Fraud

Been thee done that thee is No anesthesiologist in ANY NETWORK at least on Long Island

 

[mscher]

Re: Reverse Insurance Fraud

Unfortunately, it's your job to try to determine, whose in network and not, before the work is done, unless it's an emergency. It's not hard to do.

If we really want to lower insurance costs, we have to start doing a little heavy-lifting for ourselves.

 

[wajajaja02]

Re: Reverse Insurance Fraud

had that, note on my admissions papers aetna providers only, one particular anesthetist i remembered as not being in network showed up and ask for the routine permission sign up for a cardioversion, I declined, he ****, told him we would get some body else , he could except the sign without financial responsibility, or the cardiologist can proceed with out a anesthetist like he had done two days ago. he gave in. It was my fifth time for this procedure

 

[walk-on]

Re: Reverse Insurance Fraud

I've seen the same thing with my insurance. I've also seen the providers delay sending in the claim and billing me BEFORE sending it in. The story changed when I stated that the claim had not been sent in by them.

I also wonder about the insurance if they have a list of people to not try to scam. Seems like they used to pull this crap on me a lot more before I called them on it every time.

 

[TilliamWe]

Re: Reverse Insurance Fraud

Your state department of insurance would the be the one who regulates (and regulates the crap out of) the insurance industry. Make them aware of the practice. If it violates the insurance practices and procedure laws in your state, they will do something. If it doesn't, then they won't. Good luck, you have work to do.

 

[captharv]

Re: Reverse Insurance Fraud

Anesthesioligists are usually NOT in network, because they don't want their $$ to be tied to a contract dictating X dollars for a Y procedure. They also have the highest rate of malpractice insurance of any medical speciality.
When I had a quad bypass, the insurance company paid my out of network Dr. as if he was in network, which he consented to before the surgery.
Note: a 100 grand surgery and the out-of-pocket ws only $800. However, we (my employers people and I) did the right forms and asked the right questions.

 

[joed]

Re: Reverse Insurance Fraud

In Canada we paying nothing for those services. It's all part of the health system.

 

[TilliamWe]

Re: Reverse Insurance Fraud

Yeah, and what do you pay for taxes a year, joe? And what's a pack of smokes? It all sounds great, until you go to get health care. No thanks.

 

[triumphrick]

Re: Reverse Insurance Fraud

In Canada we paying nothing for those services. It's all part of the health system.

Are you bragging??

My Canadian wife wants ABSOLUTELY NOTHING to do with the health care system in Canada.

By the way, what's your point??

If you haven't noticed, your form of health care isn't going over very well in our country.

My British relatives have told me all of their doctors have left Great Britain for other countries. The doctors that are left are Arab and leave a lot to be desired for their lack of skills.... PM me. I will provide a link to his rant on British doctors...

 

[kenmyfam]

Re: Reverse Insurance Fraud

Calm down guys, I think it was just a statement that it is covered here in Canada. I don't think it was knocking anything or anyone.
The Canadian health care system does leave a lot to be desired without a doubt. It is however what we have and have to use. Company health care benefits in addition to the basic coverage are extremely good to have.

 

[joed]

Re: Reverse Insurance Fraud

It does leave a lot to be desired. But everyone has coverage. People don't go into debt over medical bills.

 

[levittownnick]

Re: Reverse Insurance Fraud

Thanks for the input. I think I will try the NY State Department of Insurance.
Part of the point that I am trying to make is that the insurance industry in general complains about fraud and I think rightfully so, but for them to do the same thing is doubly wrong, especially since they are targeting the people who can least afford it and in general are the people without the where-with all to challenge them. Plain and simple I think that this is "just a business decision" for them. They know well, what they are doing, they are the worst kind of theves. (My opinion.)