Insurance Fraud?

[Geo-TH,In]

Had an appointment with my dermatologist. She was 45 minutes late, I had an emergency, so I walked out. The lady at the desk asked me if I need another appointment? I told her to tell the Dr. that I don't wait 45 minutes for anyone and tell her she is Fired! It felt good saying Fired.

Guess what, yes that's right, my insurance got billed for an appointment the Dr wasn't there for. My co-pay is only $12, which I'll pay.

Is it insurance Fraud if a DR bills the insurance co for services they never did? Almost afraid if I call my insurance they will make me pay the full amount.

I did the same thing to my pulmonologist after she was an hour late, wore flip flops and told me, what other Dr's confirmed, to be a Lie. I did stay for that appointment, but told the people on the way out I will no longer need her services. They called me a few days later to make another appointment, and I told them to to tell the DR "She was Fired!"

So is it insurance fraud for a Dr to bill an insurance co for doing nothing? Or should I just keep my mouth shut?

I'd go it again, best feeling one can get, even if it cost $12. I felt like Donald nnalert saying "You are Fired!"

I'm putting my new Dermatologist on notice. I'm going to tell him he will pay me if he keeps me waiting for an appointment. Wonder how far that will go?

Where do Dr's get off thinking they can be late for work. Wouldn't you fire an employee that was an hour late? I'm paying a DR, so why aren't they my employee?

George

 

[TomH in PA]

Appeal to the insurance company. If you don't tell them the doctor didn't show up they'll never know.

 

[NY 986]

I don't think it matters that you had an emergency even though I sympathize with you. It's been a lloonngg time since a doctor has been on time with me. I think you have to give sufficient notice (24 hours) to cancel out to not be billed. They did this subject as a bit on Seinfeld.

 

[MarkB_MI]

Report it to your insurance company. You made an appointment, you appeared when you were supposed to and your doctor failed to take care of you within a reasonable length of time. It's one thing if were at fault for missing an appointment, quite another if she was at fault.

If insurance refuses to pay, and you refuse to pay, the worst she can do is ding your credit report. If you don't report it to insurance, you're a participant to fraud.

 

[wisbaker]

Yes it sounds like insurance fraud, but heck I think when an insurance company denies a claim and it's proven they should of paid it it should be fraud and the CEO of the insurance company should take the felony conviction and do time. But in the real world it doesn't work that way. They billed your insurance company because YOU had an appointment and didn't cancel within the time frame that the doctor set. If you tell your insurance company the doctor didn't deliver the service they'll deny the claim and then the doctor will bill you for the whole amount, how far do you want to fight it? If the Doctor sues you or sells it to a collection agency (then you get to deal with those bottom feeders joy of all joys) and they sue you you might get a judge to rule in your favor because you were there and they weren't able to deliver the service.

If you think it's bad now just wait until we have the full specter of government run medicine. Ask any one who uses the VA system how wonderful it is and how much you get to wait for anything. Ask a Canadian about their healthcare ask them why some Canadians have become "medical tourists" getting medical procedures done in Florida while their there for the winter. To quote Bachman Turner Overdrive "you ain't seen nothing yet"

 

[Tony Vidlak]

George I agree 100% with you,You basically hire a Dr. why cant you fire them? You"re paying them to do a service.My wife has vertigo back in June she had a bout with it she went to see her ENT
haven"t seen her for 10+ years.The Dr says I haven"t seen you for a long time proceeds to tell us she fell down on the beach while on vacation and got vertigo so she can sympathies with the wife,Says you seem to be doing better, see you.Sent me a bill for $200.didn"t do one physical thing to my wife? Ive since asked her how she can justify this charge ? No reply from the Dr. yet !!!!

 

[NY 986]

I think in New York all the doctor has to do is show they were engaged in patient care at the time of the appointment to allow the billing to go forward.

 

[bo]

Whoa! I use the VA and I NEVER had to wait more then 15 minutes to be seen. Never. The doctors were excellent and some have even called me at home to find out how I'm doing. The VA hospital here is better than any commercial doctor I've been to. I have private insurance and can see any doctor I want, but, I go to the VA because of the quality of the staff and care. Don't bad mouth the VA.

 

[mjbrown]

I had an 8 o'clock apt. with my doctor, first patient of the day and he was over a half hour late. I can see how some cases may require them to run longer than planned but if you're a half hour late for the first apt. it's only going to get word as the day goes on.

 

[oldtanker]

(quoted from post at 17:43:29 08/04/12) Whoa! I use the VA and I NEVER had to wait more then 15 minutes to be seen. Never. The doctors were excellent and some have even called me at home to find out how I'm doing. The VA hospital here is better than any commercial doctor I've been to. I have private insurance and can see any doctor I want, but, I go to the VA because of the quality of the staff and care. Don't bad mouth the VA.

I can bad mouth the VA all I want too. I've been fighting with them for over 15 years. Been seeting in a waiting room for up to 3 hours has my appt time to be seen. VA has been telling mt for near 10 years I need new knees but they want me to wait till I'm 62.....another 5 years.

This is the same VA who told my FIL when he told his doc there was something wrong with his heart.....they said no it your lungs due to the asbestoses so they gat an appt for him with a civilian clinic for a breathing test. Doc there took about 2 minutes to listen to his cheat, put him the the hospital over night and did an angiogram the next morning. When he woke up he was told by the doc he needed a quad bypass......FIL says when....the following morning at 6 AM. Doc told us that he had been within 3 days of a major heart attack. If the doc at VA had convinced him that it was his lungs he would have been dead 5 years ago.

Getting back on topic. No not fraud. Would be fraud had you stayed,the doc never showing and then them billing you. Bout the only thing you can really do is report it to the state med board.

Rick

 

[Earl Gray]

I have asked many Canadians about their health care system, and they love it! I don't know where you got the myth but you are misinformed. And they pay about half of what we do and their life expectancy is at least 2 years longer. I live close to Canada, have relatives in Canada and visit often!

 

[Big Deal]

Firing someone because they were 45 minutes late...I've seen that act before.

 

[Goose]

Can't vouch for the rest of the system, but the VA health care in Nebraska is great! I'd say it's on a par with some of the best civilian health care I've gotten.

Every fall they send me a notice that it's time for my annual physical with the number to call for an appointment. Never takes over a week or ten days to get an appointment.

For routine eye exams, hearing tests, etc, also never takes over a week or so to get an appointment. The best eye exam I ever had was at the VA. This gal asked questions and did tests that no civilian eye doctor ever did, and I've been to the best.

For basic health concerns, you have an assigned doctor, so you always see the same doctor.

Like I said, I can't vouch for the rest of the country, but here in Nebraska VA care is great. .

 

[Dean]

Your doctor was most likely making his rounds at the local hospital or, perhaps, nursing home before office hours. Sometimes they get tied up.

Dean

 

[Goose]

Depends on why they're late.

I once arrived for an appointment with my family doctor. The nurse told me he was running a few minutes late 'cause he had to run home and let his dogs out. Some things are understandable.

 

[Anonymous-0]

Sometimes the Dr. can be tied up or a previous appointment runs over time. I can understand that. I had an appointment with a specialist that I had to pay for out of my own pocket and had to wait about 40 minutes cause her previous appointment ran late. Then what really took the cake was when about 15 minutes after what would have normally been the end of appointment, the Dr. said she'd have to charge me if I take up any more time!!! I never went back but felt like asking what my time is worth since I had to wait 40 minutes cause you were late. I couldn't believe it! I had a 1 hour appointment cut down to 20 minutes, then added 15 minutes but anything over that I'd be charged extra for. I got ripped off 25 minutes!!!

Another Dr. I saw years ago billed healthcare for minimum 15 minute appointments. He often ran late and I only got about 5 minutes with him. If you added up all the 15 minute appointments he billed for worked out to about 16 hours a day and he was only there for 8 at the most.

 

[Billy Shafer]

I wouldn't put my dog in a VA hospital. I waited 11 hours for an Agent Orange test. Because I had a letter from them telling me to report fro a test. 11 hours and then they came out and told me there was no test.

My father in law had an operation at the VA hospital in Dallas.Three days later he still had the bandages from the operation on. My wife had to change them for him.

Two of my friends died in VA hospitals from neglect and screw ups.

 

[Dean Olson]

I set my appointments for 1st thing in the am on the days my Dr. doesn't have rounds. Neither of us are late for that one and it works great for me.

Never heard a positive opinion of the VA till this thread. Here in Houston you get an appt. DAY not an appt. time. 1st come 1st serve. I've taken Dad in at 7am and sat with him till 5pm and told to come back the next day. He rarely see's the same Dr. twice in a row. He does get good care, eventually, but we do advocate for him and stay on top of them. Dr.'s and nurses are over worked and very indifferent. It's definitely like herding cattle in that place.

 

[NCWayne]

How about the mess that BCBS has been putting in commercials around my area here lately? According to what they are saying hospitals, and other medical professionals routinely charge for things not done. The gist of the commercial is that you go in for say an MRI, an EKG, and another test all at one time (basically more than one test, image, etc). When the insurancde company is billed they get to pay for you checking in, wearing a gown, etc, etc, etc for each test or image. In other words you check in once, wear one gown, etc, but the insurance company gets billed like you did each thing seperately for all of them instead of just once. So, they get paid for you checking in several times, wearing two or three gowns, etc, etc, etc. If this isn't fraud I don't know what is, and as far as the insurance companies are involved it is too....but according to the commercial they haven't been able to stop it.

If we want healthcare reform in this country then it's crap like this that needs to stop. Quit charging for things not done, quit marking up 25 cent pills and charging 25 dollars, etc, etc, etc. THEN healthcare costs might actually be a bit more managable.

 

[Wile E]

Most doctors have a cancel fee, even though she was late, ---you pay. She is just billing everybody due to her late practices. It is of course BS.

 

[TomH in PA]

Yup. My daughter often arrives at the hospital at 5am for one or two surgeries before doing rounds; lots of things can happen before an 8:00 appointment.

 

[gtractorfan]

Recently I too had an appointment with a specialist (dermatologist) to remove a mole from my face. I was shown to the room in a reasonable amount of time (half hour) but then waited.. and waited... for TWO hours! I set myself a deadline, if the doctor didn't come by then I was getting up and going out in the hall- and I did. When a nurse came by a bit later I told her I was feeling sorry for my wife (still in the waiting room- she'd been waiting 2 and a half hours) That brought action, the doctor came and took care of my mole in less than 2 minutes. I was starting to wonder if their day would end and I'd spend the night. What would they say if you were still waiting when they open the next day? I have to wonder what it will be like when the new health care system kicks in.

 

[Geo-TH,In]

Personally, I think that's BS. There should be a bill of rights for patients, wait for more than a 1/2 hour and your co-pay is free!!!

Wait for more than an hour and all the bill is free.

I'm tired of waiting and mad as H@#$

 

[Rich_WI]

(quoted from post at 20:47:11 08/04/12) I have asked many Canadians about their health care system, and they love it! I don't know where you got the myth but you are misinformed. And they pay about half of what we do and their life expectancy is at least 2 years longer. I live close to Canada, have relatives in Canada and visit often!

I pretty sure this post is a joke because nobody lives that far under a rock to not know about Canadians fleeing their country just for reasonable health care. Just in case Im wrong though, clicky the linky for a short article about it. http://www.canada.com/health/Medical+tourists+have+cash+will+travel/6427473/story.html

2 year wait to get a knee worked on? When you are that old? What a wonderful health care system to make an old man wait a few years to get a knee fixed, it must take a nice load of the work needing to be done when the wait is so long the person is dead before they can get something done.

How can somebody not know about a 100 billion dollar a year industry (medical tourism)? Thats pretty much why I think I am responding to a joke because I just refuse to believe a person can be so disconnected from reality to not know about Canadians hopping a plane to come to the US or other countries to get medical services done. I thought [i:cab165210f]EVERYBODY[/i:cab165210f] knew. I thought it was impossable to [b:cab165210f][i:cab165210f]NOT[/i:cab165210f][/b:cab165210f] know.

 

[farmer boy]

Contrary to what the right wing media says about Canadian health care , most of it's not true. Life threatning situations are a 1st priority from what I've seen. While it is true that wait times for certain procedures may be longer, it's just a fact of life. At least in Canada we have a choice, we can choose to wait and have the procedure done here in Canada for "free"(not actually free) or pay to have it done in the States. Americans have no choice but to pay(either through insurance or not), and if they can"t afford it, they get told to get lost and die. I can't imagine having to go through the insurance BS everytime I visited the hospital. Other thing that most don't realize is that Canada has private healthcare. From what I understand, a doctor opens their own private clinic and get paid by the government based number of patients/procedure performed. If they don't have enough patients, they aren't profitable, and shutdown, or the the communtiy raises money so they can keep their hospital. We also fully understand the alternative, we have privitized eye and dental care, and we pay the same outrageous prices you pay, possibly more. Even the most conserative Canadians don't tend to question the principal of our health care system, though what we could do to make it better is always being questioned. The United States is the odd one out on this. The OECD (Organisation for Economic Co-operation and Development) has 30 members. Basically the most developed nations of the world. Only 3 members don't have universal health care. This part of your healthcare system ranks up(down) there with Mexico and Turkey.