What is the name of your state (only U.S. law)? Kentucky press.
My wife has been visiting an out of network psychiatrist since last fall. Fortunately, my plan will pay for his services, anyway. He refused to believe this, so we paid out-of-pocket for the first three visits. He finally filed and received money from insurance. When my wife ask about refunding our payments he said it would cover deductibles? We paid $200 for the first visit and $85 for the other two. Insurance reimbursed him $296.
For her visits this year, he has billed the insurance company a higher amount per visit ($100 vs. $85), as well as an additional billing of $100 for services? All of her visits have been the same nothing changed. He was reimbursed $300.80 cents for these visits. When my wife visited today he said it financially, we were all even? He said he was charging more to the insurance company than he did to us when we paid out-of-pocket.
It seems like he's committing fraud by charging $200 this year, per visit when he was charging us $85 last year, per visit because he thought we would be paying. Also, in order to submit the $200 per visit this year he's billing for an office visit and for "Medical Services"
At the very least, he owes us everything we paid out-of-pocket and in the worst case, he's collecting fees fraudulently. Is what he's doing actually illegal?
My wife has been visiting an out of network psychiatrist since last fall. Fortunately, my plan will pay for his services, anyway. He refused to believe this, so we paid out-of-pocket for the first three visits. He finally filed and received money from insurance. When my wife ask about refunding our payments he said it would cover deductibles? We paid $200 for the first visit and $85 for the other two. Insurance reimbursed him $296.
For her visits this year, he has billed the insurance company a higher amount per visit ($100 vs. $85), as well as an additional billing of $100 for services? All of her visits have been the same nothing changed. He was reimbursed $300.80 cents for these visits. When my wife visited today he said it financially, we were all even? He said he was charging more to the insurance company than he did to us when we paid out-of-pocket.
It seems like he's committing fraud by charging $200 this year, per visit when he was charging us $85 last year, per visit because he thought we would be paying. Also, in order to submit the $200 per visit this year he's billing for an office visit and for "Medical Services"
At the very least, he owes us everything we paid out-of-pocket and in the worst case, he's collecting fees fraudulently. Is what he's doing actually illegal?
