Doctor's Office filing false claims to my insurance?????

Question

I have Anthem Blue Cross & Blue Shield health insurance through my husband's job. We love it. We have it set up to pay $100/month which covers both of us, but we each have a $500 deductible. We haven't met that deductible yet this year.

I had scheduled (two months ago) to have my annual pelvic exam/pap smear last week. I hadn't had one since January 2007 and that was before I got married, so it was on my parents' insurance. So I'd never had one on my husband's ins policy. They cover one free one every calendar year.

So, I get there, paid for the visit (which was supposed to be free), they took me right back, weighed me (lost 2 lbs! =) ), checked blood pressure, then put me in a room. A midwife (not even a doctor) came in, asked if I needed birth control pills (I said no), and said that was the end of my exam... I told her I was supposed to have a pelvic exam. She said, "No, not today."

I called the billing dept and they said it's b/c my ins wouldn't cover it. Running out of room...

Answer 1

almost every doctor/hospital takes advantage of insurance company's and either charge too much or for thing you haven't even had done.no one seems to really read there bills since there insurance pays and were concerned with our copay only.so you wonder why insurance is so expensive or hard to get.everyone is greedy and corrupt.

if your concerned read your bills/ask for copys then correct them.they wont like you but fairs fair.they usualy say wow oops cant believe we didn't catch that thanks we will correct  that.happens all the time...they are never called on it though.

Answer 2

You have to call Anthem, and keep up on this.  Also, I'd talk to the office manager, and see if they will either waive the $65, or schedule that pelvic for free.  They should do one or the other.

It sounds like it was an error, though, and not deliberate fraud.

Answer 3

So what exactly did they charge you for?  Did they file a claim to your insurance? IF they charged you for a pelvic and didn't not preform it then I would be raising cane.

Second place a call to your insurance company and make them aware of the situation and tell them what the doctor's office did and said too you. Make sure you tell them to be on the watch for a pelvic exam that was NOT preformed. As far as the Nurse practitioner coming in and preforming the pelvic that should not be an issue, they are qualified to preform such tasks.