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This is fraud, they where fleecing the insurance company and the patient just went along for the ride. The whole point of insurance companies is that they are s

This is fraud, they where fleecing the insurance company and the patient just went along for the ride. The whole point of insurance companies is that they are supposed to be motivated by their own financial interest to fight against schemes like this, so it's shocking that they paid up.

OnlineCourage 7y ago
Billing is done largely manually, there is a lot of room for human error.
- wyldfire 7y ago
  No way, this was totally deliberate fraud. The physician likely included all of the accompanying diagnostic codes for ultra rare/serious symptoms/history so it wouldn't get rejected by the insurer. Plus when asked for an explanation by the reporter they didn't opt to fessing up to a mistake or explain why the charge was necessary: they offered no comment whatsoever. Their fraud relies on insured patients not reading EOBs (because many of us don't).
  - OnlineCourage 7y ago
    Fraud on the part of the practice, yes possible. The parent comment seems to imply the payer is at fault or committing fraud.
    - EamonnMR 7y ago
      I thought it was obvious so I didn't spell it out, but yes this is the practice defrauding the insurer.
lsaferite 7y ago
Did you read the full article by chance? Saying 'the patient just went along for the ride' insinuates that the patient was complicit when in reality the patient reported the whole incident themselves after they received the bills. They did this even though they didn't have to pay anything. And they told the provider they were going to report them. > "I made it very clear [to the doctor's office] that I was unhappy about it," Kasdan says. In fact, she told them she would report the doctor to New York state's Office of Professional Medical Conduct. > Kasdan says she was not told that the throat swab was being sent out of network at the time of her appointment, though it's possible one of the many papers she signed included a broad caveat that some services might not be in network.
- EamonnMR 7y ago
  By "patient just went along for the ride" I meant to say that her bills where collateral damage.

OnlineCourage 7y ago

Billing is done largely manually, there is a lot of room for human error.

wyldfire 7y ago
No way, this was totally deliberate fraud. The physician likely included all of the accompanying diagnostic codes for ultra rare/serious symptoms/history so it wouldn't get rejected by the insurer. Plus when asked for an explanation by the reporter they didn't opt to fessing up to a mistake or explain why the charge was necessary: they offered no comment whatsoever. Their fraud relies on insured patients not reading EOBs (because many of us don't).
- OnlineCourage 7y ago
  Fraud on the part of the practice, yes possible. The parent comment seems to imply the payer is at fault or committing fraud.
  - EamonnMR 7y ago
    I thought it was obvious so I didn't spell it out, but yes this is the practice defrauding the insurer.

lsaferite 7y ago

Did you read the full article by chance? Saying 'the patient just went along for the ride' insinuates that the patient was complicit when in reality the patient reported the whole incident themselves after they received the bills. They did this even though they didn't have to pay anything. And they told the provider they were going to report them. > "I made it very clear [to the doctor's office] that I was unhappy about it," Kasdan says. In fact, she told them she would report the doctor to New York state's Office of Professional Medical Conduct. > Kasdan says she was not told that the throat swab was being sent out of network at the time of her appointment, though it's possible one of the many papers she signed included a broad caveat that some services might not be in network.

EamonnMR 7y ago
By "patient just went along for the ride" I meant to say that her bills where collateral damage.