Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP Posting-Version: version B 2.10 5/3/83 based; site houxz.UUCP 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.)