by east30s » Sat Nov 28, 2009 01:21 pm
My insurance pays 50% of my mental health therapy sessions(im in nyc).....my doctor has agreed to bill his standard rate to the insurance company ie $150 per hour ...the insurance would pay $75 to my doctor and since i cant really afford to pay $75(ie remaining 50%) my doctor has agreed to take $35 from me instead.......my doctor is a kind caring individual.....and i dont want this act of altruism to get anyone in trouble....is this legal, etc?
Posted: Sat Nov 28, 2009 01:39 pm Post Subject:
Absolutely. Your policy only states that it will pay 50%, but if your doctor agrees to charge less, thats between you and him.
Posted: Sat Nov 28, 2009 01:42 pm Post Subject:
thanks.....so the insurance company doesnt care that in reality my doctor is really only recoupin $75 plus $35 = $110 vs the $150 which is his standard rate....ie he doesnt have to charge $110 to insurance company instead....where they pay $55 and i pay $55?
Posted: Sat Nov 28, 2009 01:45 pm Post Subject:
Like I said, if he agrees to charge you less, thats his decsion. Besides, the money the insurance company pays does not belong to them, it's your money. Similiar situation, my pediatrian is a family friend and doesn't charge us for doctors visits that my carrier reiumburses me for.
Posted: Sat Nov 28, 2009 01:55 pm Post Subject:
ok thanks.....just wanted to make sure that from a legal perspective it wasnt against the law.....sounds like its not.....can i ask...are you an insurance expert?
Posted: Sat Nov 28, 2009 01:57 pm Post Subject:
No I am not an expert.
Posted: Sun Nov 29, 2009 05:16 am Post Subject:
No I am not an expert
But he is correct. :D
Posted: Sun Nov 29, 2009 05:47 am Post Subject:
By law this is classified as insurance fraud.
"Routine waiver of a patient's copayment or deductible."
I had to defend myself early in my profession because of this.
Posted: Sun Nov 29, 2009 01:45 pm Post Subject:
By law this is classified as insurance fraud.
"Routine waiver of a patient's copayment or deductible."
This is not what we are talking about.
Posted: Sun Nov 29, 2009 05:26 pm Post Subject:
not sure i follow....are you saying if the doctor WAIVES copayment or coinsurance it is considered insurance fraud but if he charges you a lesser copayment/coinsurance, its ok?
Posted: Sun Nov 29, 2009 06:17 pm Post Subject:
Lowering one's price in order to save a customer's deductible is not illegal. It is not illegal to waive a deductible as long as the insurance company is not being overcharged for anything the policy covers. However, you maybe recieving substandard services.
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