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The doctor's office charged my insurance over $950.00 for a general, routine physcial for my son, who is only 20. This doctor is not a specialist and some of the charges were ficticious. My daughter saw a nurse practitioner there and they charged $298 by double-coding ($163 for office visit/ $135 for extra time) She was only there about 20 minutes (never saw a doctor).

The insurance company has flagged him for future reference on possible ficticious charges. I do not have to pay what charges my insurance didn't cover. My question is, if I write him a letter to tell him what I think of his ridiculous charges and that's why my family will not go to his office again, do you think he will care? Is it a waste of my time to write him a letter?

2007-01-30 06:36:54 · 4 answers · asked by TPhi 5 in Health Other - Health

4 answers

Since you have already reported this problem to your insurance, I suggest you let them handle this. Attempting to 'up-code' is a severe offense and can lead to not only monetary penalties, but jail time as well. Your insurance company should forward your complaint to their fraud and abuse department so an investigation can begin. At this point, if I were you, I would not bother with the doctor and help the insurance company in any way you can.

I am a CPC (Certified Professional Coder)

2007-01-30 06:48:58 · answer #1 · answered by EMS_5 3 · 0 0

I would ask to speak to the doctor about the billing concerns. (The person doing the billing may be a major idiot and not entering the codes properly) If the doctor refuses or you are not given an acceptable answer, don't go back and you are under no obligation to explain the change.
If you want to write a letter, send a copy to the state board with the explination of why you left(can we say insurance fraud?)

2007-01-30 14:52:45 · answer #2 · answered by Bamabrat 6 · 0 0

I can't see how this will help either you or him. He clearly knows he is commiting fraud so receiving a letter from to that fact will accomplish nothing. I commend you for alerting the insurance company. Hopefully he will be arrested for fraud and lose his license but that is not your worry. Just find another doctor.

2007-01-30 14:47:18 · answer #3 · answered by Anonymous · 0 0

let the insurance get him, don't go back, after he is in jail he will know why!

2007-01-30 14:44:21 · answer #4 · answered by kat_luvr2003 6 · 0 0

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