4 ms·
> This is all separate to your claim: of course, if your doctor agreed to charge you $x+200 (leaving aside the reality of negotiated and contracted fee schedule
by aianus 10y ago
> This is all separate to your claim: of course, if your doctor agreed to charge you $x+200 (leaving aside the reality of negotiated and contracted fee schedules) and refund you that $200, then absolutely yes - this is insurance fraud.
If you charge $X more for an Epipen vs. the market rate for a generic epinephrine autoinjector but offer a $X discount for uninsured persons (or a smaller $Y discount for those with copays or deductibles), it is the same scam.
Maybe not legally, but effectively.
- FireBeyond 10y agoWhat you need to remember in this case is that the delineation comes FROM the insurance company. They wash their hands of the co-pay entirely and say "no, we+your deductible are covering this (part of the cost)". That becomes the insurance benefit in total. Your co-pay also comes out of your pocket, entirely separately. There's no fraud, because that's how the insurer defined the separation themselves (for other reasons).