Hi Community,
I shared a situation earlier how a private clinic made fraudulent $10k claim to my insurance with all the fraudulent and insurance covered $2K (sent check to my address). : Medical Provider Fraud and being charged for $10K for $0 cost service – summary : unbundled claims, unrequested & unapproved testings, unperformed (phantom) items, no proof of service rendered (didn’t provide any testing results or documentation), no bill sent, bait as in-network and switch to out-network bill, up-coding etc.
I”m trying to work it out as you guys recommended talking to insurance, authorities and the clinic.
I talked to the clinic again and the clinic says
they won’t correct out-of-network filing or any of the wrongly charged items (ofc they don’t admit to it) but they want me to send the $2K check that the health insurance issued and they won’t bill me the outstanding (false) $10K charges. And if I don’t send the check then they’ll send the bill to debt-collectors.
= my understanding is that they want the $2K cash which is more money that they could’ve earned if they reported it correctly (in network annual checkup) without having to report to IRS, Tax. and not really expecting my out-of-pocket payment as people will be reporting & suing. (Think they overcharged for the insurance money) but it’s just all my speculation
I don’t know how much of this is empty threat and how much of this is actual complication.
Can they send it to bill collectors when,
the bill/charge itself is fraudulent ? they haven’t provide any bill to me yet and refused to send me itemized bill the service was rendered two month ago and the insurance processed it about a month ago (it just happend) they haven’t provided any testing results or anything to prove that any of the service was actually rendered
My understanding is that once the (non existing at this point but they can create) bill is handed to the debt collection agency, it will be much harder to sort out and the agency won’t care whether the bill itself is fraudulent or not.
so I can see why a lot of the victims have sent the check the clinic asked, but also worried that
they’ll eventually bill me the $10K (there’s no guarantee that they’ll drop the bill) and me complying with what they suggest can be taken as my agreement to the fraudulent bill/transaction and any issue arises later then I can’t argue
If i try to work with authorities (which I contacted already) and could go to the court, but it looks like it’s a long process and it won’t be fixed in time
But I’m also worried that if I don’t do what they say then
They’ll push it to debt collection and it will bring in more complications and also hit my credit record I could’ve wrapped this up by just giving $2k check from the insurance but later they’ll ask $10K and debt collection won’t care whether the bill was legitimate or not
it was a long story, but in short, I’m wondering if their threat is not just bluff and realistically, what would be the best move given the situation.
Any thoughts and advice will be appreciated.
submitted by /u/Hot_Cranberries
[link] [comments]Hi Community, I shared a situation earlier how a private clinic made fraudulent $10k claim to my insurance with all the fraudulent and insurance covered $2K (sent check to my address). : Medical Provider Fraud and being charged for $10K for $0 cost service – summary : unbundled claims, unrequested & unapproved testings, unperformed (phantom) items, no proof of service rendered (didn’t provide any testing results or documentation), no bill sent, bait as in-network and switch to out-network bill, up-coding etc. I”m trying to work it out as you guys recommended talking to insurance, authorities and the clinic. I talked to the clinic again and the clinic says they won’t correct out-of-network filing or any of the wrongly charged items (ofc they don’t admit to it) but they want me to send the $2K check that the health insurance issued and they won’t bill me the outstanding (false) $10K charges. And if I don’t send the check then they’ll send the bill to debt-collectors. = my understanding is that they want the $2K cash which is more money that they could’ve earned if they reported it correctly (in network annual checkup) without having to report to IRS, Tax. and not really expecting my out-of-pocket payment as people will be reporting & suing. (Think they overcharged for the insurance money) but it’s just all my speculation I don’t know how much of this is empty threat and how much of this is actual complication. Can they send it to bill collectors when, the bill/charge itself is fraudulent ? they haven’t provide any bill to me yet and refused to send me itemized bill the service was rendered two month ago and the insurance processed it about a month ago (it just happend) they haven’t provided any testing results or anything to prove that any of the service was actually rendered My understanding is that once the (non existing at this point but they can create) bill is handed to the debt collection agency, it will be much harder to sort out and the agency won’t care whether the bill itself is fraudulent or not. so I can see why a lot of the victims have sent the check the clinic asked, but also worried that they’ll eventually bill me the $10K (there’s no guarantee that they’ll drop the bill) and me complying with what they suggest can be taken as my agreement to the fraudulent bill/transaction and any issue arises later then I can’t argue If i try to work with authorities (which I contacted already) and could go to the court, but it looks like it’s a long process and it won’t be fixed in time But I’m also worried that if I don’t do what they say then They’ll push it to debt collection and it will bring in more complications and also hit my credit record I could’ve wrapped this up by just giving $2k check from the insurance but later they’ll ask $10K and debt collection won’t care whether the bill was legitimate or not it was a long story, but in short, I’m wondering if their threat is not just bluff and realistically, what would be the best move given the situation. Any thoughts and advice will be appreciated. submitted by /u/Hot_Cranberries [link] [comments]Read Morer/HealthInsurance