UPDATE Part 2: I think my chiropractor is committing insurance fraud

Alright so for a few of the folks who commented on my last post, this is old news but my doctor/chiropractor who I go to regularly (2x per month) told me he would cover my costs of each visit. He told me on my first visit he was in network and would charge me out of network because he would get more money. Asked me that I bring in any and all bills and that he would pay them so long as I brought in checks from the insurance company.

Here’s the update piece. I called my insurance company finally. Explained the whole situation – all they told me was he was in fact, out of network and that I was liable for upwards $3,000 in claims. I told them I have been visiting this person since January and have not received a bill. I told them he told me he’d pay the bill and that I should bring them checks I get from the insurance company. The lady on the phone told me that “if it’s a verbal agreement there is nothing wrong with this”. Okay fine, nothing wrong? The checks are addressed to my name (please note, I don’t actually know this but have only seen this from friends/coworkers with the same insurance plan who’ve received these checks and brought to him).

They then told me I’ve met my deductible etc etc etc and the only way I’d receive a check is if those bills are satisfied at which point their portion of out of network coverage beyond the out of pocket max / deductible would be essentially refunded to me.

I think I’ve cracked it. The guy charges people out the a$$ to rack up a bill over the max/deductible, tells the insurance company it’s all paid etc and then I bring the check to him after insurance sees I’ve overpaid past the amount my insurance says I’m liable up to.

So. On this list of felonies I see 1) insurance fraud (he isn’t charging me anything and the insurance company is paying him still) and 2) check fraud (using checks addressed to me and cashing them himself).

Here’s my plan of action. 1) called insurance (done – they have no idea what the F they are saying and think I’m a dumb blonde), 2) going in to his office and asking for a confirmation on why i haven’t received a bill yet and getting confirmation I won’t be liable for the amounts being charged (and recording this, I live in a one-party state so this is ok), 3) bringing this up to my HR team and their benefits group, 4) see what happens.

I’m scared to get a bill for that much and don’t really have it. I’ve been running on his word for too long and he’s never even told me how much he charges. Obviously I have enough evidence between my experience and coworker experience to take this to court if I got a massive bill and he didn’t pay as he said he would (to all of us) but I’m still trying to get over the fact that insurance thought this whole situation was ok…

Would love some more feedback and input. Last post everyone told me this was fraud and I know so no need to go back over that but this is crazy. Stay tuned for part 3!!!