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Posts Tagged ‘Doc’
Doctors’ Groups Plead With Congress to Pass ‘Doc Fix’
www.medpagetoday.com WASHINGTON — With less than one week until a 21% Medicare reimbursement cut for physicians takes effect, doctors’ groups were on Capitol Hill Wednesday pleading for Congress to stall the cut. “We must pass HR 4213; we must keep doctors’ doors open,” Lori Heim, MD, president of the American Academy of Family Physicians (AAFP), said at a Wednesday morning press briefing at the Capitol.
Dr. Kurtz attended our Hands-On Lab in St. Louis, MO and shared his experience with us. If you want to find out more about KMC University’s Hands-On Lab, please visit us at www.kmcuniversity.com
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I Need Help Understanding Why This Isn’t Insurance Fraud? if Not- Why Aren’t There Any Safeguards for Insured?
True Scenario:
Go to Physician
He is employed by the hospital you work for.
Your insurance is through that hospital, your employer.
The physician has signed a contract with and is a preferred provider for your insurance- as your PCP.
You have a health condition that requires you to receive the pneumonia vaccination every 5 years.
You go to Dr.s office and they tell you the vaccine is not covered by your insurance. The cost will be $120.
You decide to go home and verify (5yrs ago it was covered same doc/same insurance)
The insurance company says it is covered.
You call the physicians office. You get the Tech. They say that “it is covered but they don’t pay me enough to do the shot. So we don’t use the insurance on that. You must pay the $120.”
Now another patient, with medicare, gets same shot- his insurance is filed. He pays nothing.
Is It a Common for a Doc Use Insurance Fraud?
Let’s say a patient dies that has health insurance but another patient needs an expensive operation, otherwise they die, and doesn’t have insurance. Is it common for the doc to use the deceased persons insurance to help out the non-insured person so that they can live? If so, does this happen often, or very little?
Is This Health Insurance Fraud? if Not, Shouldn’t Insurance Have Safeguards Against This?
True Scenario:
Go to Physician
He is employed by the hospital you work for.
Your insurance is through that hospital, your employer.
The physician has signed a contract with and is a preferred provider for your insurance- as your PCP.
You have a health condition that requires you to receive the pneumonia vaccination every 5 years.
You go to Dr.s office and they tell you the vaccine is not covered by your insurance. The cost will be $120.
You decide to go home and verify (5yrs ago it was covered same doc/same insurance)
The insurance company says it is covered.
You call the physicians office. You get the Tech. They say that “it is covered but they don’t pay me enough to do the shot. So we don’t use the insurance on that. You must pay the $120.”
Now another patient, with medicare, gets same shot- his insurance is filed. He pays nothing.