Insurance Fraud?

[Rachel140 0]

I just received an EOB from my insurance stating they paid for hernia repair. Only one problem - I PAID CASH!!! As well as never signed or was told I was having hernia repair. So confused- what do you guys think??

[Rootman 1,101]

I think it definatly deserves a call, after all if you paid cash then the hospital is double dipping. Do they say you still "owe" anything to the provider as a copay or part of a deductable? The provider may come back at YOU and triple dip the payment.

[MeMeMEEE 206]

Where did you have your surgery - in the US? I ask because there is a lot of fraud with Mexico third party billers and hernia repair. Did you have a hernia repaired during your surgery?

I just received an EOB from my insurance stating they paied for hernia repair. Only one preblem- I PAID CASH!!! As well as never signed or was told I was having hernia repair. So confused- what do you guys think??

[reallyrosy 161]

Maybe you need to contact the hospital and ask them to reimburse you for the hernia repair. Or maybe the hosp billed insurance for the hernia repair only?

You have the answers. Think it thru before getting riled up and jumping to unnec. Conclusions.

[Pookeyism 1,143]

Look at your itemization for your surgery. Even if you paid a lump sum fee they have to disclose what you are paying for, so they can not come back and say it didn't include this or that. Look it over and see if there is any mention of you paying less due to a co-morbid condition or hernia.

Look at the breakdown of what was paid by your insurance. Does it have things on it that show definite double payment? Anest. fees? Hospital room, the pro op tests, etc...

If there is any doubt contact your insurance ASAP...

[Forensikchic 528]

I paid cash for my surgery at a private hospital. I was told by my surgeons office that if he repaired my hernia, they would file that on my insurance but nothing else. Maybe that is what happened to you. As it turned out, I had a hernia repair, however my surgeon didnt charge for it and therefore, it wasnt filed with my insurance. Cool guy.