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Path: utzoo!watmath!clyde!burl!ulysses!mhuxl!houxm!houxz!halle1
From: halle1@houxz.UUCP (J.HALLE)
Newsgroups: net.med
Subject: Re: insurance and doctors fees
Message-ID: <866@houxz.UUCP>
Date: Fri, 22-Jun-84 13:38:11 EDT
Article-I.D.: houxz.866
Posted: Fri Jun 22 13:38:11 1984
Date-Received: Sat, 23-Jun-84 03:48:37 EDT
References: <764@phoenix.UUCP>
Organization: AT&T Bell Labs, Holmdel NJ
Lines: 21

>Is it legal for doctors to vary their charges for a visit depending on
>the type of insurance you've got? I ask this because I called an
>acupuncturist and asked for his fees and the woman told me it depends
>on the type of insurance I have. That sounds fishy.

>What purpose does insurance if doctors just raise their prices if you've got it

It is unethical, and probably illegal in many cases.  If your insurance company
should find out, they will consider his UCR (usual, customary, and reasonable)
charge to be no more than his lowest charge, which means you may be stuck
for the difference.  It is a federal offense to do this for Medicare or
Medicade patients.  And if the doctor participates with Blue Shield, he is
in violation of his contract and is subject to civil and criminal (fraud)
charges.  If you know of a doctor that does this, report him.
(N.B.  This is not the same as a doctor who charges everyone the same, but
chooses to take a loss on someone who just cannot afford to pay.  The latter
is compassion, the former is insurance fraud.)

If anyone in New Jersey knows of a specific instance of this insurance-based
charging going on, please let me know.  I will forward, in confidence, the
information to the proper authorities.  (Yes, I have BC/BS contacts.)