Did my healthcare provider commit insurance fraud by adjusting billing?

I have health insurance and needed a CT scan, but my insurance requires prior approval for imaging and was dragging their feet with the approval. Rather than rescheduling the appointment I asked the imaging center for a self-pay cost, since I likely won’t hit out of pocket max anyways. They gave me a price I was happy with, ~$400, so I went ahead and paid it up front.

About a month later I got a bill from them because they had billed it to my insurance, this said the imaging was $5000 with a $1000 insurance discount, so I was responsible for $800 worth of my 20% co-insurance (I had already met my deductible with other care). Bill was for $400 since I had already paid $400.

I called them to complain about them billing my insurance for something I had self-payed and after many phone calls and some months later, I noticed that they had credited my bill down $400 so that I owed them nothing. So in the end they still got paid like $3600 for a procedure that we had both agreed up front would be $400 total. Sure they “helped” me out, but is this insurance fraud by basically covering my coinsurance portion after the fact just so they can bill my insurance company for far more?

submitted by /u/threxxual
[link] [comments]
I have health insurance and needed a CT scan, but my insurance requires prior approval for imaging and was dragging their feet with the approval. Rather than rescheduling the appointment I asked the imaging center for a self-pay cost, since I likely won’t hit out of pocket max anyways. They gave me a price I was happy with, ~$400, so I went ahead and paid it up front. About a month later I got a bill from them because they had billed it to my insurance, this said the imaging was $5000 with a $1000 insurance discount, so I was responsible for $800 worth of my 20% co-insurance (I had already met my deductible with other care). Bill was for $400 since I had already paid $400. I called them to complain about them billing my insurance for something I had self-payed and after many phone calls and some months later, I noticed that they had credited my bill down $400 so that I owed them nothing. So in the end they still got paid like $3600 for a procedure that we had both agreed up front would be $400 total. Sure they “helped” me out, but is this insurance fraud by basically covering my coinsurance portion after the fact just so they can bill my insurance company for far more?
submitted by /u/threxxual [link] [comments]Read Morer/HealthInsurance

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