Surprise Billing

I heard a commentary this morning on a medical Surprise Billing situation and though I would reprise my own experience. However to this day I remain convinced I was not victim to Surprise Billing, but instead of medical fraud.

In brief, I changed medical insurance carriers and my new plan included a free preventative-medecine annual check up. I contacted a new (to me) physician and checked that this was covered, it was, and booked the physical. All went well, she was nice enough, they did my height and weight and took blood and urine etc.

A few months later, I received a bill for a few hundred dollars for services "not included" in the free check-up. So I challenged this. The physician would not speak to me about this, her staff and billing people would not speak to me about this, the medical insurance people would not provide details of the charges and so on.

After multiple calls and emails, an insurance person finally told me what the "not included" charges were, and they were for tests and activities which had not happened. The doctor had checked boxes thinking they would be automatically approved and she would be paid, but in my case they were not and she as not. In fact, the insurance clerk told me the payment for the free annual check-up was so low, that doctors routinely padded the bill in such a way. The reason that this had come up in my case was that the physician had checked boxes which were not routinely paid, and she had checked boxes for things which were not done.

I made a formal complaint to the insurer, the bill was waived, the doctor was counselled on billing procedures and the case was closed. She received no sanction and still appeared in the insurer's list of approved professionals.

I called the state licensing board for MDs and was told this is not something they handle but that this did appear to be billing fraud, and asked if I would like them to send their list of attorneys who handle this type of case!

I didn't hear of this type of thing in the surprise billing commentary, but I do wonder how common it is. My experience suggests both adding in and then charging for extra services, and billing for services which did not even occur, are established medical procedures.

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