Know the Insurance Game

I was just talking to a doctor and heard yet another new disturbing trend in the insurance industry, which is why as students you really need must learn how to handle billing and insurance properly.

The doctor had a patient come to him and receive care. Bills were submitted to the insurance company, and paid. Months later, the doctor received a letter stating that a mistake had been made and that the patient had not been covered by a policy at the time, requesting a refund of everything they paid toward that patient’s care. The doctor refused to pay the money back, as it was the mistake of the insurance company who told him the patient was covered when he verified the patient’s policy information (!).

Since then, the insurance company has been taking a portion of the payments from other patients’ reimbursements who are covered and receiving services in that office. In other words, the insurance company is essentially garnishing the checks of the doctor until the “refund” they wanted is paid off. 

The only way to handle such behavior is to contact the state insurance commissioner and file a formal complaint, as well as contacting the state chiropractic association so they can alert other members of the problem and, if there are enough infractions, start a class action lawsuit against the offending (and offensive!) insurance company that is stealing your money.

Unfortunately, a huge difficulty in dealing with health insurance companies is that they are not obligated to tell you factual information when you verify benefits, and they have an automated message that comes on before any call is received that says, “Our information may or may not be accurate.” You must be very careful in dealing with these companies. I was always pretty lucky, but times are changing.

On a side note, the patient was upside down on a house he bought subprime (stupid) and so is penniless and is another one of the people caught up in the “housing crunch” (another word for people who couldn’t budget money properly), so the doctor can’t get the patient to hold up their end of the responsibility for THEIR insurance policy. As usual, the health care provider is left paying for the patient’s inability to uphold financial obligations.