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Agreed. Just got contacted by collections about unpaid services. Contacted the doctor's office about this and they said our insurance denied the claim and they

Agreed. Just got contacted by collections about unpaid services. Contacted the doctor's office about this and they said our insurance denied the claim and they couldn't get in touch with us to resolve the matter. Turns out they were submitting to our old health insurance company, and using our old home address. We were also at this office about 3-4 times before and 3-4 times after the procedure that went to collections. Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping. Also, the amount of time spent following up with doctors, payments, procedures, claims, etc is mind boggling. At least 4-8 hrs a week. Getting an answer about what is and isn't covered also seems to be some kind of black art.

FireBeyond 8y ago
> Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping. Let's not beat about the bush, this is _insurance fraud_, not "double dipping". The provider has to assert to the insurer that they have not been paid for that service rendered when they bill insurance.
- HarryHirsch 8y ago
  Let me guess, the Attorney General is not interested in prosecuting, because if he were physicians would be more honest. The advice would be to let the dubious bills go to collection, they'll never end up in court because that would make a paper trail.
  - FireBeyond 8y ago
    The AG doesn't need to be involved. Insurers, for all their faults, _love_ to hear about provider fraud and can make that an entirely uncomfortable situation for the provider.

FireBeyond 8y ago

> Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping. Let's not beat about the bush, this is _insurance fraud_, not "double dipping". The provider has to assert to the insurer that they have not been paid for that service rendered when they bill insurance.

HarryHirsch 8y ago
Let me guess, the Attorney General is not interested in prosecuting, because if he were physicians would be more honest. The advice would be to let the dubious bills go to collection, they'll never end up in court because that would make a paper trail.
- FireBeyond 8y ago
  The AG doesn't need to be involved. Insurers, for all their faults, _love_ to hear about provider fraud and can make that an entirely uncomfortable situation for the provider.