Healthcare Fraud - Who Can You Trust?

Bobby Cole said:
I don’t remember how many years ago it happened but in the vast industry of auto repair, Congress passed an edict that said that auto repair shops Had to give an estimate of the work to be performed and the actual cost of the job couldn’t exceed a small percentage (I can’t remember what the % was) and any work performed that wasn’t in the initial estimate couldn’t be charged for.
Moreover, if the mechanic didn’t repair the auto, the shop couldn’t charge anything at all.

Seems to me that the same laws should apply to all things including in the medical field. If, in a consultation the doctor says that the gall bladder has to come out then the patient should be free to shop around for the best price w/ good quality work before anyone pulls out the cutlery.

Now, just to backtrack a bit, if I remember right, D. Trump said at some point that clinics, hospitals and Dr.’s offices should have something like a “menu” that states how much a procedure and medications cost before a patient agrees to be worked on.
The way it is now, we sign a piece of paper that says who will pay for the procedure (no matter how much it costs) or office visit. To me, that’s a grand opportunity for insurance fraud, lies and a misrepresentation of facts.

SURPRISE !! Your office visit was $450 for 5 minutes of the Doctor’s time. Would you like a scrip for the newly squires anxiety attack?
Click to expand...
As with many things Trump said, they are being fought or ignored whether we want them or not. Hubby and I regularly are contacted for wellness exams etc by our insurance companies. I figure I'm saving my insurance company lots of money by not going. And yet, they are doing the calling.
???
 
Mary Stetler said:
As with many things Trump said, they are being fought or ignored whether we want them or not. Hubby and I regularly are contacted for wellness exams etc by our insurance companies. I figure I'm saving my insurance company lots of money by not going. And yet, they are doing the calling.
???
Click to expand...
On the matter of insurance companies, our insurance provider (Devoted) has a program that bypasses a primary healthcare provider by “being” a healthcare provider
We’ve had so many bad experiences with “button pushers” and doctor’s offices that suddenly opt out of using a particular insurance company that we opted for the service our insurance company provides.

No more guess work on how much an office visit is going to cost or how much poking and prodding they’re going to do. If we think we have a problem then we call Devoted and they arrange to have one of their own “on-staff” doctors or a NP speak with us on a zoom call. If we need a referral to a specialist, we get one.
Note: Obviously my last experience with a Pulmonologist they had on their referral list was a hack so I’ll be reporting that experience to Devoted.
Anyway, they give us each $150 a year to spend on health related equipment and an additional $50 a month for OTC products.

Basically, what they’ve done is eliminated a lot of chances for over billing and fraudulent billing by doctors and their offices for services that either aren’t necessary or not performed at all.
 
Bobby Cole said:
I don’t remember how many years ago it happened but in the vast industry of auto repair, Congress passed an edict that said that auto repair shops Had to give an estimate of the work to be performed and the actual cost of the job couldn’t exceed a small percentage (I can’t remember what the % was) and any work performed that wasn’t in the initial estimate couldn’t be charged for.
Moreover, if the mechanic didn’t repair the auto, the shop couldn’t charge anything at all.

Seems to me that the same laws should apply to all things including in the medical field. If, in a consultation the doctor says that the gall bladder has to come out then the patient should be free to shop around for the best price w/ good quality work before anyone pulls out the cutlery.

Now, just to backtrack a bit, if I remember right, D. Trump said at some point that clinics, hospitals and Dr.’s offices should have something like a “menu” that states how much a procedure and medications cost before a patient agrees to be worked on.
The way it is now, we sign a piece of paper that says who will pay for the procedure (no matter how much it costs) or office visit. To me, that’s a grand opportunity for insurance fraud, lies and a misrepresentation of facts.

SURPRISE !! Your office visit was $450 for 5 minutes of the Doctor’s time. Would you like a scrip for the newly squires anxiety attack?
Click to expand...
What keeps a patient from getting second and third opinions?
 
Bobby Cole said:
On the matter of insurance companies, our insurance provider (Devoted) has a program that bypasses a primary healthcare provider by “being” a healthcare provider
We’ve had so many bad experiences with “button pushers” and doctor’s offices that suddenly opt out of using a particular insurance company that we opted for the service our insurance company provides.

No more guess work on how much an office visit is going to cost or how much poking and prodding they’re going to do. If we think we have a problem then we call Devoted and they arrange to have one of their own “on-staff” doctors or a NP speak with us on a zoom call. If we need a referral to a specialist, we get one.
Note: Obviously my last experience with a Pulmonologist they had on their referral list was a hack so I’ll be reporting that experience to Devoted.
Anyway, they give us each $150 a year to spend on health related equipment and an additional $50 a month for OTC products.

Basically, what they’ve done is eliminated a lot of chances for over billing and fraudulent billing by doctors and their offices for services that either aren’t necessary or not performed at all.
Click to expand...
If you do not mind - what is your premium payment for Devoted per year?
 
Marie Miller said:
If you do not mind - what is your premium payment for Devoted per year?
Click to expand...
Devoted Health, like most Medicare insurance companies, has a variety of plans, depending on what coverage you want, whether you qualify for Medicaid assistance, and maybe even where you live.
If you look at Devoted Health’s website, then you can see the different plans they offer, as well as the states they are active in. Here is their website:
www.devoted.com

Devoted Health

www.devoted.com
 
Yvonne Smith said:
Devoted Health, like most Medicare insurance companies, has a variety of plans, depending on what coverage you want, whether you qualify for Medicaid assistance, and maybe even where you live.
If you look at Devoted Health’s website, then you can see the different plans they offer, as well as the states they are active in. Here is their website:
www.devoted.com

Devoted Health

www.devoted.com
Click to expand...
Thank you Yvonne but we are all set. I was looking for an answer from Bobby Cole.
 
Marie Miller said:
What keeps a patient from getting second and third opinions?
Click to expand...
My dad wanted a second opinion. I was driving him everywhere when he couldn't drive safely any more. Since the second-opinion doctor was out of his coverage, the visit was $900.00. When the doctor came in, the first thing he asked was "Who is your doctor?"
I said, "Why does that matter?"
He said, "We need to know."
I said, "Why do you need to know?"
He said, "So we can do a thorough evaluation." (We both could tell the doctor was irritated & my dad started to chuckle)
I said, "No, you want to get his opinion so you can give us the same opinion without doing anything. We don't need to spend $900.00 for a tape recording of his first doctor's opinion." We left. And the doctor actually sent us a bill for $900.00 which went in the trash.
 
John Brunner said:
That's beyond infuriating.
Click to expand...
Another example of Patient Dumping:
A friend needed knee replacement. Her situation was a bit complicated because she was born with Cerebral Palsy. THE NEXT DAY after her surgery, while I was visiting, her doctor came in the room & said, "OK, time for you to go home, now."
I said, "What? She's barely conscious; why would you release her less than a day after major surgery?"
The doctor said, "She's not sick; she only had surgery."
I said, "Shouldn't she rest at least another day so she can be fully awake?"
Doctor: "Well we don't want her to get an infection."
I said, "Hospital-acquired infections are usually caused by doctors who don't follow sterile procedure & don't wash their hands between patients."
He left the room in a huff. I spoke to the hospital's director who allowed her two more days.
 
Tony Nathanson said:
My dad wanted a second opinion. I was driving him everywhere when he couldn't drive safely any more. Since the second-opinion doctor was out of his coverage, the visit was $900.00. When the doctor came in, the first thing he asked was "Who is your doctor?"
I said, "Why does that matter?"
He said, "We need to know."
I said, "Why do you need to know?"
He said, "So we can do a thorough evaluation." (We both could tell the doctor was irritated & my dad started to chuckle)
I said, "No, you want to get his opinion so you can give us the same opinion without doing anything. We don't need to spend $900.00 for a tape recording of his first doctor's opinion." We left. And the doctor actually sent us a bill for $900.00 which went in the trash.
Click to expand...
Tony, I can only tell you how things went recently with my hip/spine issue. Kid glove treatment, conversations into details on my level of comprehension, physicians and PAs working so closely together that appointments were same or next day after being referred. No bill but $89 for selected local numbing for spinal injection. Now physical therapy is dealing with all to keep them and my PA updated on progress and future needs.
 
Tony Nathanson said:
Another example of Patient Dumping:
A friend needed knee replacement. Her situation was a bit complicated because she was born with Cerebral Palsy. THE NEXT DAY after her surgery, while I was visiting, her doctor came in the room & said, "OK, time for you to go home, now."
I said, "What? She's barely conscious; why would you release her less than a day after major surgery?"
The doctor said, "She's not sick; she only had surgery."
I said, "Shouldn't she rest at least another day so she can be fully awake?"
Doctor: "Well we don't want her to get an infection."
I said, "Hospital-acquired infections are usually caused by doctors who don't follow sterile procedure & don't wash their hands between patients."
He left the room in a huff. I spoke to the hospital's director who allowed her two more days.
Click to expand...
Tony, SO went home on the morning of day two after major spinal surgery. It was his decision. The house was set for his recovery.
 
You must log in or register to reply here.
Back
Top