To whom do I report medical over-billing concern of a MD provider?
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Anonymous
| I have an issue with medical over-billing from a MD provider. This is an issue that is not related to Medicare or Medicaid or the MD market place insurance- I have commercial insurance through my employer. I have discussed with top level of provider’s office and they do not agree with my concern. I have discussed with my health insurance and they told me they pay their claims assuming that they are submitter by the provider in good faith so they do not have a channel to look into it. Is there any health agency to whom I can report the issue for further investigation? |
Anonymous
| Your insurance company |
Anonymous
| You could report to the state, but they're in bed with the doctors. Your best option is to leave reviews warning other potential patients. |
Anonymous
| Your state's Insurance Commissioner. |
Anonymous
| You could try filing a case in small claims court. It would get their attention. |
Anonymous
| So, OP, there is a gap between the billed amount and the amount that your insurer says is "normal and customary for your area", right? perfectly normal. |
Anonymous
You would have to have a claim that they owe you money though. If you aren’t getting charged for the over billing, you wouldn’t be able to do this. |
Anonymous
| Are they billing for services they didn’t provide? |
Anonymous
| Are you being billed for the difference? |
Anonymous
They are billing for a test that was not ordered by my referring doctor. I did not know the test was run until I received the bill for the test in addition to the ones that my physician ordered. |
Anonymous
Presumably the OP is being charged. Up-coding often leads to higher copays. |
Anonymous
| Attorney General of MD: https://oag.maryland.gov/i-need-to/Pages/health-billing-insurance-complaints.aspx |
Anonymous
Who are the they claiming sent in the order for the other test and what documentation was provided? This sounds like an easy case to win, but you'll probably have to go through the state or court. Is this a lab or another provider? |
Anonymous
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It might be a test that was added after the fact. If I get labs back and the patient is anemic, I add an iron panel and sometimes B12 and folate, depending on the patient. Maybe it was something like this?
Sometimes a letter of medical necessity needs to be written. |
Anonymous
| So it is a lab that you are concerned about rather than your doctor? |