Dental Insurance Fraud or Stupid Employee
Last week I went to the oral surgeon inorder to get an implant placed. I filled out the consent forms. Then they had me pay. I was surprised the co-pay was so much and I asked if she was sure this was with the insurance. The receptionist then fliped some papers around and says "yes, you have Humana, right? ". I agreed and then paid. The procedure went okay, thankfully.
I get home, and I gave my husband the receipt. He was also shocked about the price. He told me to co-pay should have been about $900.
I got no bill- only a receipt. I called and asked for a bill with medical codes on it. They then ask for me to send pics of my insurance cards over. I had sent them pics of my insurance cards months ago, I have proof. Anyway,I finally got the bill and I see that they didn't process this procedure with the insurance. They had me pay in full with a small discount they give to people with no insurance.
I called today and I told the lady working in billing that she didn't process this through the insurance. (This is the only person I've been dealing with as far as billing goes.) Then she starts telling me nicely that she will process it, and IF there is any overpay, I'll be reimbursed. 🙄 "It will take 4 weeks", she says. I tell her , calmly that I called my insurance already, it's covered. I have overpaid. She should have processed through the insurance. I have never paid in full and then got insurance in after the fact.
She then gets really nasty and tells she needs to figure out what's my co-pay so she can figure out the difference. Then I ask her when will this be done? Then she says, she doesn't know. Then I tell her I will dispute the charge with my CC provider if it's not done before the week is through. She's really frazzled now and tells me she'll have it done by the end of the week.
Is this possible fraud? Or idiocy? If I had just let her do her thing, would she have processed the payment with insurance too and double dipped? Who makes a patient pay full price and THEN processes with insurance. Wth. Is there anything illegal about this as far as insurance is concerned. Any advice?
submitted by /u/StrangeBoat9843
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