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Post by aljack on Jun 9, 2016 2:30:22 GMT
The school I work at requires a physical form stating we are able to work for our state license every year. The director dropped the ball and forgot to tell us it was needed by July which is a change from the usual end of August deadline. So she hounded a previous client who is a pediatrician to conduct physicals and fill out our forms. He is going to see staff on his day off at his office and bill our insurance for the visit as an allergy, headache, etc. to receive payment. A co-payment would be due at time of service. My director arranged this and sent the email to the staff. I can't believe he is agreeing to this but maybe I am overthinking this.
wont insurance companies ask why a grown woman is seeing a pediatrician? And one that they have never seen before? It also seems like it would violate code of ethics?
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Post by myshelly on Jun 9, 2016 2:36:32 GMT
I thought everyone gets one free physical a year. So I'd be unhappy paying a copay.
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Post by papercrafteradvocate on Jun 9, 2016 2:37:09 GMT
It's not cool to lie that it is allergy etc. when it's for something else.
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Post by Eddie-n-Harley on Jun 9, 2016 2:39:22 GMT
Have you tried to get an appointment with your own doctor?
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Deleted
Posts: 0
Oct 7, 2024 13:36:55 GMT
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Post by Deleted on Jun 9, 2016 2:40:39 GMT
There are a number of issues here and I wouldn't participate. I'd see my own doctor.
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GiantsFan
Prolific Pea
Posts: 8,456
Site Supporter
Jun 27, 2014 14:44:56 GMT
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Post by GiantsFan on Jun 9, 2016 2:57:57 GMT
It sounds like insurance fraud to me.
I would try to see my own doctor or go to urgent care. And most insurances have a once a year no copay physical.
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dantemia
Full Member
Posts: 315
Jun 27, 2014 19:28:17 GMT
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Post by dantemia on Jun 9, 2016 2:59:08 GMT
Fraud -
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Post by cmpeter on Jun 9, 2016 3:01:44 GMT
I wouldn't be concerned about the adult at the peds office...ours used to give me my flu shot when I took the kids in for theirs. But, she billed it correctly. My dh broke his ribs at a soccer game and ended up in the Children's Hospital ER because it was the closest place he could get himself to. But, they billed it correctly.
I would be concerned about the hinky billing and look to schedule my own appt with my doc.
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Post by kellybelly77 on Jun 9, 2016 3:01:51 GMT
It sounds like insurance fraud to me. I would try to see my own doctor or go to urgent care. And most insurances have a once a year no copay physical. Only if the employer plan is not grandfathered. Grandfathered plans can still have cost sharing on preventative care I believe.
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Deleted
Posts: 0
Oct 7, 2024 13:36:55 GMT
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Post by Deleted on Jun 9, 2016 3:02:44 GMT
No way would I risk my insurance coverage for something like that.
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Post by jamielynn on Jun 9, 2016 3:11:13 GMT
I believe all insurance companies have fraud tip lines. Why don't you anonymously call the schools. The insurance company can determine on their own whether it's fraud.
Myself, I'd call my doctor and get an appt. if she couldn't get me in I'd ask someone else there to see me. If there is a copay if request reimbursement from the employer, and if it's too early for your annual appt I'd ask if your doctor could sign off for you being you've been seen within the last year.
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Post by redrulz on Jun 9, 2016 3:23:34 GMT
Ok, this may be a stupid question, but why can't the pediatrician just bill the insurance as a physical?
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Post by aljack on Jun 9, 2016 3:29:45 GMT
The school does not provide insurance since it a private Christian school. Also, my physical is not available until August since it is once a year. For the past seven years, we have been able to turn our forms in on our first day back at work. Therefore, most of us are not able to have a physical covered this early. This is why she hounded this doctor to see us since everyone was concerned about the cost.
I did not see him. To me, this is being deceitful which does not equate to being a Christain? I guess integrity is something I honor and her email screams anything but.
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Post by mrssmith on Jun 9, 2016 3:29:51 GMT
I think it sounds very odd. Definitely billing for an illness when it's just a well visit is hinky. There's still time before July to get to another doctor or to one of the Walgreens/CVS/Target clinics for a quick physical. I would not participate in this.
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Post by aljack on Jun 9, 2016 3:31:47 GMT
I believe all insurance companies have fraud tip lines. Why don't you anonymously call the schools. The insurance company can determine on their own whether it's fraud. Myself, I'd call my doctor and get an appt. if she couldn't get me in I'd ask someone else there to see me. If there is a copay if request reimbursement from the employer, and if it's too early for your annual appt I'd ask if your doctor could sign off for you being you've been seen within the last year. School will not reimburse.
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Post by aljack on Jun 9, 2016 3:33:22 GMT
Ok, this may be a stupid question, but why can't the pediatrician just bill the insurance as a physical? Because a majority of the women are not due to have a physical until August. Therefore, insurance will reject the physical billing code and charge the full amount to the patient.
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Post by elaine on Jun 9, 2016 3:39:39 GMT
The school does not provide insurance since it a private Christian school. Also, my physical is not available until August since it is once a year. For the past seven years, we have been able to turn our forms in on our first day back at work. Therefore, most of us are not able to have a physical covered this early. This is why she hounded this doctor to see us since everyone was concerned about the cost. I did not see him. To me, this is being deceitful which does not equate to being a Christain? I guess integrity is something I honor and her email screams anything but. The irony. Yes, it is unethical to lie when billing insurance and I agree with you that it is probably not wwjd.
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Post by ~summer~ on Jun 9, 2016 3:47:00 GMT
The doctor can't submit a code that she doesn't do. If she performs a physical on everyone then she can submit a claim for a physical and get reimbursed.
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Post by redrulz on Jun 9, 2016 3:47:50 GMT
Ok, this may be a stupid question, but why can't the pediatrician just bill the insurance as a physical? Because a majority of the women are not due to have a physical until August. Therefore, insurance will reject the physical billing code and charge the full amount to the patient. Ah, well, I can see what the employer is trying to do, but you are right to wonder about insurance fraud. I'm surprised the doctor is willing to do that AND I'm surprised that the boss told you what they were planning to do. So, what are you planning on doing?
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Post by ~summer~ on Jun 9, 2016 3:50:52 GMT
There are a lot of things off about this question.
If the women have already had physicals then they could just submit those forms.
It's surprising that most of the women have had their physicals as most people do not get yearly physicals....
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Post by aljack on Jun 9, 2016 3:56:29 GMT
There are a lot of things off about this question. If the women have already had physicals then they could just submit those forms. It's surprising that most of the women have had their physicals as most people do not get yearly physicals.... Yes, most ladies submitted their forms to be signed by their doctors since it's been less than a year but some had doctors requesting them to make an appointment. Everyone is required to submit this form to work.
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Post by myshelly on Jun 9, 2016 4:02:12 GMT
I've never heard of teachers having to submit a form like that.
I would hate that.
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Post by melodyesch on Jun 9, 2016 5:51:59 GMT
This is 100% fraud. Any doctor billing for a service they did not perform is fraud and I would report them in a heartbeat.
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Post by cade387 on Jun 9, 2016 10:12:46 GMT
A physical and a health assessment form are two different things. You can have a health assessment filled out during a physical but you cannot have a physical during a insurance health assessment visit.
Do you just need a health assessment form filled out? If so I would call your doctor and ask what they can do. You only get 15 min with the doctor and don't have time to ask about any lingering questions, etc. but it sounds better than your other options.
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mvavw
Full Member
Posts: 344
Jun 25, 2014 20:21:43 GMT
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Post by mvavw on Jun 9, 2016 10:16:52 GMT
From what I understand, it's not very hard to go beyond the scope of a physical at an appointment. As soon as the doctor discusses any concerns or chronic conditions, they have the right to bill for a regular appointment. I was told this by both a doctor and my insurance company after being double billed for a "physical." After that I refused to make an appointment for a physical and just had a "physical" at a follow-up appointment. A physical basically only covers height, weight, blood pressure and immunizations of needed.
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katybee
Drama Llama
Posts: 5,448
Jun 25, 2014 23:25:39 GMT
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Post by katybee on Jun 9, 2016 10:51:43 GMT
Is this a form required by your school or by the state? Because if it is required by the state to maintain a license, it seems to me that you would be responsible to pay the fee for the physical? Right? It's your license… so just pay for a physical.
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Post by pierkiss on Jun 9, 2016 10:56:16 GMT
I would be extremely uncomfortable doing this. Like so uncomfortable that if start looking for another job because I couldn't stand to work for such an unethical slimeball.
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Post by aljack on Jun 9, 2016 11:12:38 GMT
Is this a form required by your school or by the state? Because if it is required by the state to maintain a license, it seems to me that you would be responsible to pay the fee for the physical? Right? It's your license… so just pay for a physical. This is not my license. It's the school's.
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Post by Spongemom Scrappants on Jun 9, 2016 11:38:51 GMT
It's really somewhat mind-boggling that a physician would agree to do this and that the school would encourage people so blithely to participate in the fraud. They are putting everyone in a very uncomfortable position.
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Post by Scrapbrat on Jun 9, 2016 11:42:14 GMT
Of course it's insurance fraud. The dr. is billing the insurance companies for services other than actually performed, so that insurance will cover the bills for the physicals. That's fraud, and both your school and the dr. are participating in it. I don't see any problem with the fact that the dr. is a pediatrician, but what the school should have done was make an arrangement with the dr. to do the needed physicals at some kind of reduced out-of-pocket cost, and then (IMO) the school should have paid the cost (since it's the school's license that the physicals are needed for).
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