r/HealthInsurance • u/_MystEerie_ • 9h ago
Employer/COBRA Insurance Had a “free consultation”, and then got billed $2400 for an office visit
I had a free consultation with a doctor to discuss treatment plans he offers. Everything sounded good, so I agreed to give him my insurance information. Then I find out that he billed $2400 to my insurance for my “free consultation”. I believe this to be a fraudulent charge.
What do I do? Can I get my insurance company to fight the charge?
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u/CPandaClimb 8h ago
Call the doctors office and ask them why they charged insurance if the consult was free. Especially if you have advertisement or screen shot where it says consults are free - but also read the fine print to make sure it doesn’t say ‘after insurance’.
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u/SanfordStreet 8h ago
Just wondering…..what kind of physician charged $2400 for a consultation or office visit? I’m a retired MD with a specialty and that is about 10 times what my extended OV would be.
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u/_MystEerie_ 8h ago
A cosmetic surgeon in Beverly Hills.
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u/SanfordStreet 7h ago
I guess I picked the wrong specialty! And I did surgical procedures. Cosmetic surgeons usually do not participate in any insurance; a few may if they are dealing with malignancies but not typical.
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u/_MystEerie_ 7h ago
Sadly most of my gender affirming care goes through cosmetic surgeons who have questionable practices with insurance. Normal doctors don’t treat patients like me.
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u/Puzzleheaded_Serve37 7h ago
Depending on your location/ability to travel there are more contracted gender affirming care providers than you might think at least in the BlueCross/BlueShield network.
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u/xxxiii 6h ago
There’s a difference between medically necessary (ie gender affirming) vs cosmetic consultations by a plastics doc. It’s possible that they billed your insurance with the wrong diagnosis code or that gender care isn’t included in your insurance coverage. Cosmetics procedures are not covered by insurance so it was unlikely they would have billed out and would have likely required a consult fee paid at time of service
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u/_MystEerie_ 6h ago
GAC is covered by my insurance. They asked for an up front fee of $150 to process my insurance, but told me the consultation would be free.
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u/Jujulabee 5h ago
If it was "free" then they wouldn't have processed your insurance.
What does your EOB state as the amount you owe?
Gender conforming medical care might be covered but it would typically still be subject to your benefits just as any other procedure is.
So typically you would be liable for your deductible, your co-payment and your co-insurance as applicable.
Your issue isn't with insurance - provided that your EOB from them shows that they "covered" it in accordance with the plan. If you have a copy of your EOB you should post it redacted and you can receive helpful insight. I believe you can also google Medical Codes and determine what they state they are.
Your issue is with the provider. If they advertise a free consultation is should be free and it is fraud if they then charge you. Even the $150 fee was fraudulent. I would contact them and threaten to report them to the Medical Association as well as state entity that covers fraudulent consumer advertising.
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u/Quirky_Bad_9483 5h ago
That's still a really high charge for a consultation!
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u/Quirky_Bad_9483 5h ago
PS - for some reason Reddit changed my name from Sanford Street to Quirky_Bad 9383 - have no idea why - second time
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u/_MystEerie_ 5h ago
I agree. They billed it as an office visit, of which my insurance said they will only cover $180.
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u/lrkt88 9h ago
It’s very possible the visit is free to you, meaning they will take whatever from the insurance and not bill you your out of pocket. If you have a copay, coinsurance, or a deductible, just call the doctor and ask.
If they billed the insurance for something that actually happened, it’s not fraudulent.
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u/dexter5222 8h ago
Depends on the insurance.
Local TMJ specialist got hit with fraud for advertising “free consultations” and then billing Medicare and Tricare for a level 5 consult but writing off the copay. Ended up entering into a settlement to reimburse them.
If it’s government sponsored insurance then it’s fraud, waste and abuse, if it’s commercial it’s just violating your contract with the insurance company.
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u/allthebison 8h ago
nah, my insurance lists calling visits “free” but billing insurance as a type of fraud to call their hotline for. Bet your insurance would love to know what this doctor is up to.
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u/ThellraAK 7h ago
Wouldn't that only be a problem if they were in network?
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u/megan8086 6h ago edited 6h ago
Most likely. There’s always “fine print,” but typically OON doctors do not have to accept the “contractual” processing of an EOB and are free to bill the patient however they want, whether it’s the entire balance or a flat fee or nothing at all. This scenario is cosmetic surgeon, so I’m wondering if it’s a case where the Dr doesn’t accept contracts with insurance but courtesy bills the patient’s insurance to see what kind of OON reimbursement they can get, then nothing is billed to the patient afterwards.
ETA: by “fine print” I mean there has to be a distinction notes SOMEWHERE reflecting “consultation” cost to patient after insurance. A Dr can’t advertise a free service (presumably to drum up business or something) and then turn around and bill an insurance company. That IS fraud.
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u/DesertWisdom 9h ago
Not sure that’s legal.
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u/keikioaina 8h ago
Not collecting the copay of a commercial policy doesn't break any laws so it's not illegal, but it does violate the contract that your doc has with your insurance company.
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u/ChiefKC20 8h ago
If there is no intent to collect the patient portion, this could be textbook insurance fraud. It’s definitely a violation of the network contract, but there are many state and federal laws that cover this scenario as well.
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u/Actual-Government96 6h ago
False claims act, federal anti kickback statutes, numerous state level regulations......
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u/AwfullyChillyInHere 4h ago
Assuming this is an OON provider (as many plastics surgeons are) and that this situation involves a commercial health insurer, how would those laws you cited apply in any way?
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u/That-League6974 4h ago
My guess is that what they promise is that it’s free to you, but they reserve the right to bill your insurance for any eligible reimbursement. If you have any medical issues, vs cosmetic, it may be legitimate for them to obtain reimbursement to discuss treatment.
Now, if they are billing you directly after promising the consultation is free, then that is not right!
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u/kdali99 3h ago
Call your insurance company and let them deal with it. There are regulations and processes that aren't known to us. Dealing with the Doctor's accounts receivable will probably be very frustrating. I mean, you can try, but you don't know what you don't know and they usually won't offer up the information.
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u/flannelavenger 8h ago
Im a contractor. We do consultations for projects for free. If they sign with me it is made up for on the backend. It would be absolutely unacceptable for me to surprise charge a potential client for this service in the eyes of the court system or by common sense business practices.
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u/x21wing 8h ago
There are many professions that will offer free consultations. Attorneys, mechanics, HVAC to name a few. The OP only expected it to be free because it was marketed as a free consultation. We don't know the medical specifics here, but this clearly was not standard medical treatment. It may have been elective/cosmetic or some other situation where the actual treatment (if the OP elected to take that route) was new and not yet covered by insurance plans.
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u/_MystEerie_ 8h ago
Yes, this is for cosmetic services as part of gender affirming care. The doctor offers free consultations to new patients.
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u/UniqueSaucer 7h ago
Free means they shouldn’t have even asked for your insurance information. Agree with others, report it to your insurance. My company considers this fraud.
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u/_MystEerie_ 7h ago edited 7h ago
I only gave them my insurance after the consultation and after agreeing to proceed with their services. So it was a surprise to receive a charge to my insurance that preceeds the date of my insurance authorization with them.
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u/x21wing 7h ago
You should be asking the provider then because if you went in for a free consultation and then during that consultation, you decided to proceed with their services, then it sounds like you transitioned from free into a paid service. All you really have to do is look at the insurance claim to determine what the billing was for. This is exactly how a free annual check-up works. You go in for the free (covered by insurance) visit and if during that visit you get into other services not covered by the definitions under the affordable care act, then your provider will bill the insurance company for it. It's standard practice. Given the services you are looking at, it would be wise to examine all cost estimates upfront and ask just as many cost questions as you would health related questions imo.
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u/Actual-Government96 6h ago
A free annual check-up resulting in additional charges is not even on the same planet as a free consultation resulting in charges.
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u/x21wing 5h ago
That's not the analogy I made. The analogy was that you go to the doctor for a free thing, then it turns into something that isn't free. The suggestion to the OP was to verify the reason for the charges. Everyone is assuming the free consultation wasn't free, but as the OP later stated, insurance never came into play until the OP decided to proceed with the treatment plan, so it's very likely that the charges were for activities that occurred during the appointment, but after the free consultation portion had concluded.
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u/megan8086 6h ago
You mentioned insurance authorization, so to help clarify, providers cannot obtain authorization unless they can document your need for the specific procedures to be performed (some authorizations require documentation to be submitted). So since you agreed to move forward with their services, they will bill your “consult” as a new patient exam. Without the exam, they won’t know what specific procedures will be performed to determine whether authorization would be required. They also need to know this because even slight variations of procedures could have different codes. If a provider has authorization for one code but performs one that does not, the procedure performed would be denied.
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u/_MystEerie_ 6h ago
Perhaps they are billing me to investigate my case. They have not made that clear to me, and have not responded to my request for more information. I’ll let you know once they get back to me.
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u/megan8086 6h ago
It’s quite possible that’s what happened. At the consultation, they might have taken notes while discussing procedures offered, and then once you’ve agreed to services, the doctor will review all those notes plus any health forms you may have filled out to determine what they need authorizations for. You may not be present for your case review, but the time they spend doing it is considered part of your visit and will affect the level of exam code they bill. Now, if you had gone into the consultation and decided not to pursue treatment, then there’s no cost to you and no continuing care to plan for, so no visit to bill. But once you’ve agreed to services, like someone else commented, the consult now becomes a new patient exam.
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u/_MystEerie_ 5h ago
Hmm. Sounds likely. Only problem is that they didn’t tell me about this, which means all these charges are surprises. I don’t know how much they are going to charge me when all is said and done. They have already billed me above and beyond what my insurance permits.
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u/megan8086 5h ago
All insurance companies bill more than what insurance permits and then, if they are in network, write off the difference between their contracted rate and their billed amount. Out of the contracted rate, how much you pay out of pocket depends on your contract with the insurance company.
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u/Actual-Government96 6h ago
If possible, I would not proceed with this provider. While there can be some unethical practices in specialties that don't normally contract with insurers, it's not the norm, nor is it okay. If you can't trust a Dr to honor something so basic as a free consultation (that they offered), I wouldn't trust them with my health and well-being.
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u/BumCadillac 8h ago
Was it just a discussion, or was there an examination and treatment plan decided?
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u/PraiseTalos66012 8h ago
Actually yes I do work for free sometimes. If customers want a consultation/quote it's always free...
It's extremely common for consultations and quotes to be free even when they require significant amounts of work.
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