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To: Nachum

Been dealing with this for many years now and if the employer does not pay the premium, the insurance carrier doesn’t pay the doc. End of story.

Some of my docs are seeing an occasional patient show up with coverage through some special fed plan. We always have patient pay for the service and then refund them when/if the insurance company pays. Sometimes hard on the patient but the option is not to be seen or go elsewhere for treatment. My docs are no different than anyone else, they all have bills to be paid, too.


4 posted on 04/16/2013 3:01:52 PM PDT by Grams A (The Sun will rise in the East in the morning and God is still on his throne.)
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To: Grams A

“We always have patient pay for the service and then refund them when/if the insurance company pays. Sometimes hard on the patient but the option is not to be seen or go elsewhere for treatment. “

In most states if a physician accepts patient payment other than the co-pay and/or the deductible as delineated in the doc’s signed insurance company contract, then that may constitute fraudulent billing. And if repeated often , could end with the doctor facing civil and criminal charges with possible loss of license.


8 posted on 04/16/2013 3:17:30 PM PDT by Cyman
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To: Grams A
That's under a normal situation. As soon as the ACA drops into the picture you have the federal government acting as an agent and ALL these claims go to the federal courts.

A few million low dollar value lawsuits could well swamp the courts and effectively eliminate their use for quite a long time.

In the United States, the way things work now virtually all claims of this type go through state court systems which are fairly robust and have enough personnel to handle the paperwork. Without those courts in the picture the federal courts won't even have enough parking spaces in a 1 mile radius for all the lawyers!

9 posted on 04/16/2013 3:41:16 PM PDT by muawiyah
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