Is this insurance fraud? Or the beginning of a new billing procedure to defer out of pocket deductible expenses to the next billing year.
Late last year, I I was in need of an upgrade of my CPAP (continuous positive airway pressure) machine which I use in the treatment of my obstructive sleep apnea. My physician agreed that I was in need of this upgrade and wrote an order for me to obtain a newer CPAP model. It had been at least five or six years since I had been issued the last model, and with the technology changing as quickly as it does, I needed an a better more versatile machine that was Web-enabled, etc. It was also at the end of my year as it relates to my insurance deductible being paid up. Obtaining this new machine would or should have not hit my out-of-pocket expenses . I expected that my health insurance should have paid for this machine in total. However, my health insurance was not billed in 2019 when I received the item. Instead the company that distributes these supplies, began billing me and my new insurance insurance in “installments” starting in January 2020. What that means in essence, is that I will be required to pay for a supply that was shipped and received in 2019 over the course of 2020. I have never heard of this type of arrangement, and why would they and the insurance companies provide that as a payment offering unless the insured agrees to it. And now it is the end of July, 6 months later, and I just received in the mail this week, on July 28, several invoices for these installment payments, claiming payment is required shortly.
To wit….Is this an example of my medical provider and my insurance company in collaboration to defraud me of payment for services? I know that insurance companies are always looking for ways to deny claims.
When I was much younger, and pregnant, it was determined by my physician that I would need amniocentesis to determine if the fetus I was carrying had a genetic anomaly. Because of my age, being under 35 years old, the insurance company immediately denied payment for this service. On appeal, I stated that I was a pharmacist that frequently mixed chemotherapy, and they subsequently reversed their decision to pay. Other historical claim denials use to happen when insurance would not pay for a brand name medication, only the generic. It was decades of these denials that eventually led to the now common acceptance of using generic medications. If only these generic medications were that much cheaper than their corresponding brand named analogs. In addition, these are examples in which the insured could appeal a health insurance decision. That is no longer the case. Only a prescriber can make these appeals which in most cases is unlikely to happen unless the insured can collaborate with the physician to meet this end.
As for my current insurance scenario, I don’t know the answers, but I will be calling the supplier to find out. I will get this rectified and report back here. I will need to do some research and find the appropriate organization that can help if this is not addressed. Is it the insurance commission? Again, I will report back. A colleague of mine that had a similar circumstance with their health nsurance company and this same supplier . When he questioned the billing arrangement, they stopped sending any further installment requisitions.
It’s always something … i’m wondering if there’s anyone out there that has had a similar circumstance. Its almost like having an operation in November or December and the healthcare provider amortizes your care to the insurance over the course of the following year so that they can push your out of pocket expenses to the next year, assuming you will not need that operation again in your lifetime. You still end up paying for it and they don’t . Stay tuned