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Is this health insurance fraud?

West Palm Beach, FL |

Last year my husband went to a rehab facility. His insurance didn't cover his stay. They said they would charge $9500 for the stay. The day he went into the facility I started a new job, and my insurance coverage started that day. Because they couldn't get an answer right away from my insurance they made us pay the $9500. They filed a claim for $17,850.00. They said the amt they quoted was a discount for uninsured. They received 70% of the claim and made us pay the difference. Is it common practice to make the patient pay an amount, perform the service, and then filed a claim for more?

Attorney Answers 3


  1. It depends. If the facility is a provider under contract with the insurance company it has to bill for the services provided.


  2. If your husband got the rehab he is responsible to pay whether or whether not he had insurance.


  3. The answer in part depends on the type of insurance. If a Preferred Provider plan, the facility could only collect what it agreed with the insurance company was reasonable for its services. You would still be responsible for the deductible and the co-pay up to your maximum out of pocket per year. If it is an indemnity plan, which are rare these days, your insurer will only pay what it deems customary and reasonable for the service, but the provider will still demand to be paid its going rate. One interesting tidbit in Florida - absent a prior agreement, you can always challenge a medical provider's bill as being excessive and unreasonable, but given your insurer already had an agreement that won't be necessary.

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