I just heard an NPR story on "surprise billing" which reminded me of an episode in my own medical journey. It was not only an unexpected bill, but I am confident it was also medical fraud.
I had signed up for a high deductible medical insurance plan so I could qualify for an HSA. One of the things about this particular plan was its preventive care, free seminars and self-care seminars, free tele-medicine and a free annual check-up.
This last benefit was very attractive as I typically only go the doctor when I am sick or injured and could not remember my last annual check-up. So I found a doctor on the approved list, called to ask if she took this particular plan and would do the check up to which she said she did, and made an appointment.
All went well - height, weight, blood, urine etc, and I left happily, with no bill and no co-pay. A week later, I went back for the results, all was fine (I needed to reduce salt and sugar, increase exercise) and again, no bill and no co-pay.
Several months later, I received a bill from the insurer, a "Denial of Claim", telling me I owed north of a thousand dollars. I called the insurer to query this who referred me to the doctor. I called the doctor and her office manager wh confirmed she did the billing said she knew nothing about it and that I needed to speak with the doctor. The doctor would not speak to me. I sent some emails asking for an explanation of the bill and why it existed since I had specifically asked for the free annual check-up included in my plan. Crickets, and when I called, the doctor would not speak to me.
I called the insurer on multiple occasions and each time, a different person told me that they could not tell me anything and that I had to speak to the doctor Their system was that the provider listed codes for procedures, tests, supplies etc and any question about the codes was with the provider. Finally, what appeared to be a little old lady told me what some of the codes were and they were for tests I had not had such as electro-cardiographs, and supplies that were not used such as syringes, needles, gauze and sutures.
I asked three of the parent-doctors at school who told me that this "padding" is routine, especially for free annual check-ups which have really low reimbursement rates. If the doctor had not been so ambitious in claiming for the extra money, she would have got away with it. They told me to make a complaint to the insurer about billing fraud which I did. I later received a letter saying the insurer had investigated and found no evidence, they had counselled the doctor (whatever that means) and that the bill had been waived. I still wonder why, if there was no evidence of false claims, the bill was waived.
I also received a letter from the doctor firing me as a patient.
One other interesting note. I called the state's doctor licensing office. They told me they do not deal with this, although billing fraud looks to me like professional malpractise, and offered to send me a list of attorneys who specialise in suing doctors!
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