For the average person, the details of their medical bills probably seem like unnecessary information. Although many insurance programs have cost-sharing obligations for patients, those obligations are often up front and flat rate. For example, if you have a deductible, you will likely have to pay that specific dollar amount prior to your appointment.
If you have a deductible or co-insurance, you will either have to pay a certain amount of money out-of-pocket or a certain percentage of your total bill. Looking over each line of your bill may seem unnecessary.
It is a common practice for people to focus solely on their obligation and not on the details of the bill itself. However, the individual line items on your medical bill could hide frightening information. You could be the victim of insurance fraud without realizing that your doctor has billed you inappropriately.
You should always make sure the bill matches your experience
Medical providers constitute the biggest risk for insurance fraud, not patients getting benefits they don’t deserve. Insurance fraud committed by medical care providers can take a number of different forms. Sometimes, they will bill for services they never provided. Other times, they may bill for a different but similar procedure that costs more money.
Any time you receive a billing statement from a medical practice or an explanation of benefits from either your private insurance carrier or Medicare, make sure that the names of the procedures listed reflect the care you received and that the dates match when you last saw that medical care provider. In the event that things do not match up, you may want to contact the medical practice to see if there was some kind of mistake.
Make sure you’re not implicated through discounts or rewards
Doctors have to meet strict ethics requirements as part of their profession, such as not paying or receiving kickbacks for referrals or performing specific services. However, some physicians will give patients discounts or rewards for seeing preferred providers or choosing specific treatments or medications.
Depending on the circumstances, such practices could implicate you and other patients in a fraudulent billing scheme, potentially leaving you vulnerable to fraud charges. Even if you face no legal risk, looking out for and reporting potential billing fraud or kickback schemes protects you and every other taxpayer who contributes to government insurance programs.