Surprise bill and possible fraud

Hey insurance experts, just was made aware of some weird situations and was hoping for some direction what could be going on. I broke my wrist earlier this year and have been in occupational therapy since then. The good news is I’m almost done but the bad news is today I received a bill for my therapist via my insurer saying I owe their full fee because my therapist is out of network. This is all news to me, and the bill date is a month ago. I’ve been paying a $50 co-pay dutifully after every appointment and I was just at my clinic yesterday and nothing was said to me about owing hundreds of dollars for an appointment that was a month ago.

I haven’t logged into my portal until today because when my insurance company sends emails about explanation of benefits, they always say it is not a bill, so my feeling on the matter has been I’m not gonna worry about amounts I might not owe. I can see that maybe was the wrong tactic to take.

I say that because, when I logged in, I discovered every other appointment than the one I was sent the bill for has been billed to a surgeon at the clinic, not my therapist. I’ve seen these people’s names on the wall, but I’ve never met any of them or even so much have said hello to these men in the hallway. This is so bizarre to me and it seems purposeful rather than that they mistakenly billed surgeons versus my therapist. I think the surgeons own the practice, but again these are not therapists, and are not providing me the services that are being billed for.

I’m wondering if this is a fraudulent situation or is there a perfectly sensible explanation for this? Should I ask the bill I’m being asked to pay be billed to one of these men instead of my therapist, as that has been the precedent? Now I’m wondering if the situation has been beneficial to me and, if I raise the issue and it gets fixed, if I’m gonna get a bill for hundreds of dollars for every single OT visit.

submitted by /u/Effective-Pattern-23
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