Back in January, I attended a conference in Las Vegas for work. It began on January 2nd, but DH and I flew out New Year's Eve so we could be there for the festivities. The conference ended on January 5th, so we flew back home on the last flight. I attended this conference with three colleagues whose spouses also came along.
In February I got an explanation of benefits statement from my insurance company telling me they had paid $65 to my former doctor on January 5th for an office visit I supposedly made! I immediately called the company to tell them there must have been a mistake. First, I was in Las Vegas at the time. Second, I am no longer a patient of this doctor and have not been one since September. Third, the supposed visit date was a Saturday, a day when the office was not even open!
The claim rep called the office hoping to get things straightened out over the phone. The receptionist told her that they were open that day and that he personally had seen me! This really pissed me off because it's not as if it was a case of mistaken identity. I'd been a patient at that office for six years, and everyone who works there knows me by sight. Plus I know there was no way they were open because they are NEVER open on Saturday.
The claim rep said they would request further documentation from the office. I told her I had receipts for airfare, hotel, and theater tickets that could prove my whereabouts as well as several witnesses who were my traveling companions. She said not to worry about it, that they would take care of it.
I got a bill a few weeks ago from a collections agency demanding a copay for my nonexistent visit. I called the insurance company again. They said my doctor's office had not responded to their request. They also gave me a number to report fraud, which I did. I've been told not to engage with either the doctor's office or the collections agency while they investigate, and supposedly an investigator is going to contact me. But I am starting to get very concerned about this.
No one has been in touch. DH and I have good credit. I'd hate to see it ruined by a $20 bill, but it's the principle of the thing. I wonder if they are doing this to a lot of other people thinking they will just pay it. (Their office now sees primarily senior citizens with a lot of chronic health issues, so it would be easy enough to get away with it.)
What do you think I should do?
I would say call the insurance company again for an update. I would not call the doctor or the collections people, that may only end up hurting your case in some way.
Vanessa
I agree with vanessa - do NOT call the Dr.'s office or the collections agency, but if the collections agency calls you, simply state the charge is in dispute and being investigated, then HANG UP. Do not let them engage you, don't reveal it's the insurance co. investigating.
Call the insurance company and see if they can have the account pulled from collections or at least freeze any action until this is resolved.
Then call the fraud line again.
Then if this continues, I'd call the non-emergency number at the police dept. and ask to speak to someone who handles fraud/corporate crime 'cause methinks there is some embezzlement going on with whoever bills out of the Dr.'s office, if not the Dr. him/herself, then an employee.
Same as above.
And be sure to document the calls you make. Even though the insruance company is on your side, it's still good to keep meticulous notes on everything, should it have to be taken to a lawyer (hopefully it doesn't get that far, but CYA).
That sucks. I agree with everyone else - follow the instructions that the fraud reporting line gave you and don't call the doctor's office or the collection agency. It has to work out in your favor - you have irrefutable proof.
Cripes! Hope you can get it straightened out. Do you have an identical twin?
Have you talked with the doctor himself, or ONLY with his office staff? The embezzling may be on the right track. It would seem rather risky, though, to do it in a way that patients still have to pay, even just $20.
When my mom's father was in a nursing home, she got a EOB from Medicare, for sizing, ordering and fitting several different things, like orthoses for his legs and feet, hearing aids, phalangeal splints, custom diabetic socks, etc., things that he wouldn't use, either because of his situation or from his nature. But the main thing was that she had durable POA for him, and she hadn't ok'd these things.
Mom was upset, and unsure what to do. She couldn't just ignore it, but if she reported it to the authorities, who knows how someone at the nursing home might take it out on my grandfather. Finally, she DID call SSA and Medicare, and took down the shell company that owned the local nursing home and others across the country.
Anyhow, this company had figured that since none of the patients or their relatives would have to pay anything, they wouldn't notice, or if they did they wouldn't care. You said your doctor has a lot of senior citizens, they'd be totally covered by Medicare and SS, so they wouldn't get a bill. I think your account was used by mistake, since you'd have to have a copay.
That is FUCKED UP. Take Daria's advice and document every conversation you have, I do that for every similar situation I find myself in because you might need it someday in case of a lawsuit or something. It's handy to be able to give a lawyer a timeline of events.
Keep calling and document EVERYTHING.
1. The Dr's office purposely billed your insurance, whether it was malicious intent or an accident (someone with a similar name) is hard to prove.
If the Dr is not responding to your claims report the office to the Texas Medical Board:
http://www.tmb.state.tx.us/ (under services for consumers)
I had a similar situation that was unresolved, but in this case the Dr owed ME money (over $700) and wasn't paying. I reported them to the TMB and got my payment in full. If that didn't work I was going to file an action in small claims court.
In your case the Dr's office made the mistake. Absolutely file a fraud claim with your insurance company- make it clear that your Dr's office is submitting a fraudulent claim on your behalf and your previous attempts to resolve the issue have been unanswered. Until the insurance knows that the Dr is to blame they are probably going to side with him and think you are trying to get out of the bill. It is up to your Dr to prove you were in the office. They might have something with your supposed signature on it from that day- ask for it, ask for paperwork, ask what the visit was for and what was done. Hell, ask them for a full medical record release!
Everything needs to be in writing. Write the letters, mail them with a signature confirmation, send them to the insurance company and your Dr's office and the TMB. I guarantee that will raise eyebrows and get them to fix your situation.
You don't want this to go to collections and it most certainly can and may have already ended up on your credit report.
Write to each of the 3 credit reporting agencies (Equifax, Transunion, and Experian) and ask them for a free copy of your credit report because you "may have been a victim of fraud." You do not have to pay for your credit report. (This is usually in reference to someone who has had their identity stolen, but for all you know that did happen, right? *wink* ) You can do this at any time, sometimes collections appear early, sometimes never at all and all 3 agencies report things differently so it's important to contact ALL 3 agencies.
Gee, can you tell I've worked in medical billing and credit reporting before? Lol.
Good luck!
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Great advice! As soon as finals are over, I am going to take it.
Call everyone, including the State Insurance Fraud Department.
HOLY SHIT I am so sorry this has happened to you dune67
But ITA with everyone here.
Write down everything you do & CYA in spades.
After which, just sit back and relax & have some pie, these things do TAKE TIME.
Its not always INSTANT apologies and remorse that is waiting in the wings.
But sooner or later the Fraud dept will find out just exactly what is going on.
Make sure you save everything from Vegas.
and I wish you loads of
with this. I too would hate to think this small amount would ruin your credit record.
Next time you speak to the fraud dept, you may want to ask them about it.
dune67 Wrote:Great advice! As soon as finals are over, I am going to take it.
NP- feel free to PM me if you need anything else or have any questions about the credit report stuff or anything else. I've got a little experience with this as you can tell !
Good luck!
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Update: It took me three calls and over an hour this morning, but I think this may finally be taken care of. First I called the insurance company. They called the doctor's office who insisted everything was kosher and then transferred the insurance rep to voice mail at some corporate headquarters. The insurance company told me to call the fraud hotline back to get further instructions. The fraud hotline told me all they do is record complaints, so I had to call the insurance company back. So when I called back and sounded very exasperated (my lovely asthmatic cough and hoarse voice no doubt added to the effect), the woman who I got that time called the doctor's office yet again. This time, the gentleman who was ready to swear in court that he personally checked me in was apologetic and said of course there was no way I could have been at their office on a Saturday. He ended up transferring her to a local billing agent who supposedly was going to fix everything.
I am hanging on to all my documentation should I need it, but I hope this is all behind me now.
I am glad it is all going to work out for you dune67
And yes by all means Please keep saving everything you have on it and continue to save it for 7 years.
Just to make sure nothing comes down the road later to bite you in the ass again.
I am so sorry you had to go through all of this.
And I know you want it to be all behind you.
But if it was me I would turn it around and sue them for
mental anquish for what they put you through.
LOL I know Thats being petty, But,hey, they were ready to take you to court, so turn about is fair play.
But that is just me.. I can be very vindictive when I want to be.
Moooohaaahhahhhahhhahhhahh ( Mad scientest laugh) LOL
But seriously, I am very happy for you that all of this is being resolved.
Please keep us posted if for some reason it goes south again.
