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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Diane J. on July 29, 2002, at 20:10:28
Hi, I was wondering if some of you on this board would tell me what you think about this: Last year I began seeing a different psychiatrist. I had already used up my insurance benefits so I was paying cash at each appointment. I didn't pay much attention to the insurance forms the doctor submitted, because I had paid him in full and I knew the insurance company was not going to reimburse him.
This year I knew I would have benefits for quite a while, so I looked closely at all the mailings I received from my insurance company. My daughter also sees this doctor and has insurance benefits. I noticed that he was billing us for family therapy @ $200 per visit. I thought there had been a mistake, and I mentioned to him that these appointments were 15-minute medication management meetings. (These were for my daughter.) I was concerned because what the insurance company did not pay I would probably be required to take care of. He told me it was an oversight, and he would set it right.
One day I completely forgot my appointment. I didn't remember it until a week later. I called the doctor and left a message on his answering machine. I apologized, said that I understood I would have to pay for the lost appointment because I knew he could not bill the insurance company now.
However, I received notice that the insurance company had paid for my missed appointment. I checked my insurance account online, confirmed this, and saw that his office had billed the insurance company three times each for two additional appointments which I had paid in full at he time of service. Every time these particular claims had been denied, as they should have been.
I asked him about this at my last appointment and he got kind of mad about it. He said that they always bill for appointments unless they receive advance cancellation. I said, you mean you bill the insurance company for unkept appointments? He said they did it to save patients from having to pay the fee. As for the claims that kept getting re-billed, he told me to talk to his billing department.
That same day I received a claim form which was for my daughter. The two appointments were listed again as family therapy @ $200 when they should have been listed as medication management @ $100. The insurance comany had denied the claim and I called them to find out why. I learned that the amount had been applied to the deductible, and that made sense. But I did not owe the doctor as much as his bill said, because it was based on the much higher fee.
I called his number and asked if his billing secretary would call me so we could straighten this out. I said we did not owe the amount stated on the bill. The next day there was a message on my machine from the secretary. She said the insurance company had finally paid on the two claims and I owed nothing.
Well, I thought this was kind of strange, because I knew the claims had not been paid and would not because the amount was applied to the deductible. I also knew I did owe the doctor money, just not as much as it said on the bill.
Is this, uh, fraud, or just bad accounting?
DJ
Posted by Tab@iT=Ha! on July 29, 2002, at 20:27:01
In reply to Does anyone know about insurance...fraud?, posted by Diane J. on July 29, 2002, at 20:10:28
Hard to say whether the incorrect billing is intentional, but it sounds mighty suspicious. At the very least it's causing you to waste time trying to keep it all straight, that's enough reason to change doctors if you can.
I used to go to a dentist that would send me bills for random amounts. After paying them several times, I started calling the office for an explanation, and every time I called, they told me the bill was a mistake. Then I started checking every payment I made, and noticed they were frequently overcharging me, compared to the insurance statement. Every time I called they would eventually refund the overcharge, thought sometimes I had to call more than once. Seemed like they were just making a practice of overbilling, and counting on people's negligence to get away with it. Hard to prove though.
Posted by Tabitha on July 29, 2002, at 20:32:30
In reply to Re: Does anyone know about insurance...fraud?, posted by Tab@iT=Ha! on July 29, 2002, at 20:27:01
Posted by mair on July 29, 2002, at 21:07:34
In reply to Does anyone know about insurance...fraud?, posted by Diane J. on July 29, 2002, at 20:10:28
Is it customary for your doctor to submit claims for sessions for which you have already paid in full? If so, who gets the reimbursement check?
Mair
Posted by Diane J. on July 29, 2002, at 21:25:58
In reply to Re: Does anyone know about insurance...fraud? » Diane J., posted by mair on July 29, 2002, at 21:07:34
> Is it customary for your doctor to submit claims for sessions for which you have already paid in full? If so, who gets the reimbursement check?
>
> MairThis is the first doctor I have had that has done this. My psychologist stopped billing the insurance company each year when she was notified that my benefits had been used up. Same with my former psychiatrist. Everybody was always pretty straightforward when it came to billing.
A check would go directly to this doctor if the appointment was reimbursed. I just don't understand why he would continue billing after the claim had been denied three times, and I had paid in full.
Posted by mair on July 30, 2002, at 7:28:23
In reply to Re: Does anyone know about insurance...fraud?, posted by Diane J. on July 29, 2002, at 21:25:58
I guess I just don't understand why he's the one submitting claims at all after he's been fully paid. If he doesn't have some affiliation with your insurer as a preferred provider or something similar, it should probably be up to you to seek reimbursement for amounts already paid. If he does have some connection, he shouldn't be billing you until after he's been paid by the insurer. What happens after he's received your reimbursement check? Is this a credit against future bills? How do you know that you're being properly creditted with all of the claims he's recovered?
Mair
This is the end of the thread.
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