It is recent and I am reporting it to Medicare as fraud. Her receptionist agreed with me when I told her I wouldn’t pay for a phone call of 5 minutes for results of a test I was entitled to. My mammogram results were mailed to me as expected.
When an insurance company rejects pre-authorization and the patient experiences a calamity because treatment was delayed, can the insurance company be sued? Are there instances where such lawsuits have succeeded?
See a medical attorney. Keep records of dates and names at every contact, along with costs attributed to damages. Damned right they can be sued and there are plenty of junk insurance companies out there. Also, your state has an insurance commissioner: Use them.
There is a movie called Bleedout. Watch it if you haven't. It is about the producer/director's battle over his mother's care. (Last time I checked, it was on HBO and maybe a few other streaming services, too.) Sad, but worth a watch.
Hi Gary - When an insurance company declines to pay, you can force an appeal. That is with the company reviewing the denial internally. If they still deny many state insurance commissioners have an office that can force an external review of the request for payment. It is adjudicated by someone outside of the insurance company. IF that fails - I would try in the courts. I wrote about this before where the patient was an attorney. He wound up paying cash (more than $100K) then sued to get the money back. He won the case but the company tried to make him take the discounted rate they would have paid instead of what he was forced to pay. SCUM.
I received a gyn exam and never received results as I always had in the past. I phoned two months after not receiving a letter and was told the doctor would call me. She did and I received the results in a 5 minute phone call. A month later she billed my insurance company over $600. Surely a letter, an envelope and a stamp would have taken more time. These outrageous bills to Medicare must be outlawed!! Since when does someone taking a test not entitled to results unless there is another fee?
Thanks for sharing this. If this was recent I would contact Medicare as this is apparently fraud. They should ask the Dr to retract the bill. If that d I sent work perhaps we can submit it to the DOJ for criminal prosecution.
First make sure it was actually a double billing and not just a late filing before suggesting fraud. Or did Medicare not cover the care in the first place?
Here's an interesting one: my father, who has medicare + a supplement, had an appointment with a NP for routine care. A surgeon evidently found out he was there and "popped in" to try to con him into the same the same unwarranted surgery he's been hammering on my dad about for ages. We are all sure it is not only unnecessary but would be catastrophic for my father's health. My father told him he was not interested and the physician left. The physician then billed my father for a consultation. The medicare + medigap combo says they won't pay for both appointments, so now my dad is left holding the proverbial bag for one of the appointments. I have urged him to complain and/or appeal. Like many people he has lots of reservations about doing so: the bill, though meaningful, won't impoverish him; there aren't many doctors in the area and he is loath to get a reputation as a complainer; he has "good" insurance, so it's confusing when they won't pay; and dare I suggest .... real men don't ask for help (or directions ??), etc., etc. It's fraudsters like this physician who give fee-for-service a bad name.... and it's beyond exasperating. There are sort of two issues here: dangerous and/or incompetent providers and those who try to game the payment system. Complaining is the only way I know to focus scrutiny on such providers and actions. It is really unfortunate that it can come at a high "cost" to the patient.
I’m in a Circle of Death mode with my brand, new Medicare. We had an experienced agent file all the entry paperwork. Yet, Medicare denied coverage AT All, claiming I had not been insured in the last 5 years prior. So, I spelled out in paperwork that, yes, I had been insured under my husband’s employer; my husband retired and that policy ended 31 DEC2023. Next thing I know, Medicare is denying claims, stating I had private, “primary insurance.” A long, infuriating afternoon of waiting on the phone, getting shifted around to different people, I was assured that the expired “primary” insurance would be removed from the record—oh! And the Part G insurance had already arranged for the crossover, but Medicare had just denied the claim outright, so it was never handled appropriately. Well, 10 days has passed. If they fuck it up again, I’m writing to their Washington DC oversight person. And, nurse that I was, I have names and dates, for what it’s worth.
Dawna - what nightmare. Let me make a suggestion. Call the local office of your member of Congress (or senator) They have staff whose only job is to clear up problems with government agencies. You might be surprised that they can help.
Except they are trumpanzees . I wouldn’t dream of contacting Pete Ricketts, whose daddy literally purchased his senate seat, or Don Bacon, mouthpiece of Charles Koch. . . In fact, my husband and I made a large contribution to his opponent. Those people are too busy stirring up trouble and obstructing anything Biden proposes.
It is recent and I am reporting it to Medicare as fraud. Her receptionist agreed with me when I told her I wouldn’t pay for a phone call of 5 minutes for results of a test I was entitled to. My mammogram results were mailed to me as expected.
Good for you, Jill!! Let us know how it goes.
Alan,
When an insurance company rejects pre-authorization and the patient experiences a calamity because treatment was delayed, can the insurance company be sued? Are there instances where such lawsuits have succeeded?
See a medical attorney. Keep records of dates and names at every contact, along with costs attributed to damages. Damned right they can be sued and there are plenty of junk insurance companies out there. Also, your state has an insurance commissioner: Use them.
***Actually—it’s a medical LIABILITY attorney you need.
Good suggestions!!
There is a movie called Bleedout. Watch it if you haven't. It is about the producer/director's battle over his mother's care. (Last time I checked, it was on HBO and maybe a few other streaming services, too.) Sad, but worth a watch.
Hi Gary - When an insurance company declines to pay, you can force an appeal. That is with the company reviewing the denial internally. If they still deny many state insurance commissioners have an office that can force an external review of the request for payment. It is adjudicated by someone outside of the insurance company. IF that fails - I would try in the courts. I wrote about this before where the patient was an attorney. He wound up paying cash (more than $100K) then sued to get the money back. He won the case but the company tried to make him take the discounted rate they would have paid instead of what he was forced to pay. SCUM.
I received a gyn exam and never received results as I always had in the past. I phoned two months after not receiving a letter and was told the doctor would call me. She did and I received the results in a 5 minute phone call. A month later she billed my insurance company over $600. Surely a letter, an envelope and a stamp would have taken more time. These outrageous bills to Medicare must be outlawed!! Since when does someone taking a test not entitled to results unless there is another fee?
Thanks for sharing this. If this was recent I would contact Medicare as this is apparently fraud. They should ask the Dr to retract the bill. If that d I sent work perhaps we can submit it to the DOJ for criminal prosecution.
First make sure it was actually a double billing and not just a late filing before suggesting fraud. Or did Medicare not cover the care in the first place?
Here's an interesting one: my father, who has medicare + a supplement, had an appointment with a NP for routine care. A surgeon evidently found out he was there and "popped in" to try to con him into the same the same unwarranted surgery he's been hammering on my dad about for ages. We are all sure it is not only unnecessary but would be catastrophic for my father's health. My father told him he was not interested and the physician left. The physician then billed my father for a consultation. The medicare + medigap combo says they won't pay for both appointments, so now my dad is left holding the proverbial bag for one of the appointments. I have urged him to complain and/or appeal. Like many people he has lots of reservations about doing so: the bill, though meaningful, won't impoverish him; there aren't many doctors in the area and he is loath to get a reputation as a complainer; he has "good" insurance, so it's confusing when they won't pay; and dare I suggest .... real men don't ask for help (or directions ??), etc., etc. It's fraudsters like this physician who give fee-for-service a bad name.... and it's beyond exasperating. There are sort of two issues here: dangerous and/or incompetent providers and those who try to game the payment system. Complaining is the only way I know to focus scrutiny on such providers and actions. It is really unfortunate that it can come at a high "cost" to the patient.
test
I’m in a Circle of Death mode with my brand, new Medicare. We had an experienced agent file all the entry paperwork. Yet, Medicare denied coverage AT All, claiming I had not been insured in the last 5 years prior. So, I spelled out in paperwork that, yes, I had been insured under my husband’s employer; my husband retired and that policy ended 31 DEC2023. Next thing I know, Medicare is denying claims, stating I had private, “primary insurance.” A long, infuriating afternoon of waiting on the phone, getting shifted around to different people, I was assured that the expired “primary” insurance would be removed from the record—oh! And the Part G insurance had already arranged for the crossover, but Medicare had just denied the claim outright, so it was never handled appropriately. Well, 10 days has passed. If they fuck it up again, I’m writing to their Washington DC oversight person. And, nurse that I was, I have names and dates, for what it’s worth.
Dawna - what nightmare. Let me make a suggestion. Call the local office of your member of Congress (or senator) They have staff whose only job is to clear up problems with government agencies. You might be surprised that they can help.
Except they are trumpanzees . I wouldn’t dream of contacting Pete Ricketts, whose daddy literally purchased his senate seat, or Don Bacon, mouthpiece of Charles Koch. . . In fact, my husband and I made a large contribution to his opponent. Those people are too busy stirring up trouble and obstructing anything Biden proposes.