Question:
When I had my surgery, I received a bill for the anestesiologist, since then

I have lost my insurance through that company (husband quit job) I just received a notice of explinations in the mail from the insurance company that covered the surgery with a check for the anestesiologist made out to my husband. I called the company and they said that I could deposit the check in out bank account and sent the money to the anestesiologist, or send it back to them to pay him. I was wondering if I kept the money and made arrangements with this doctor, if it would be insurance fraud with possible jail time. Remember, I am no longer with this insurance company and I am in a desperate financial situation. I don't know what to do here. Oh, and when I called the insurance company, she said that the claim was processed twice, what does that mean?? Please any suggestions?    — [Anonymous] (posted on October 22, 2001)

October 22, 2001
Yep, it would be fraud if you keep the money and don't pay the full amount to the doctor. It doesn't matter that you are no longer with that insurance company. They can (and will if they find out) come back at you. Insurance fraud is nasty business. Don't get involved with it. The check received in your husband's name is NOT your money.. it is to pay the doctor. Keeping any of it would morally and legally be stealing.
   — BethVBG

October 22, 2001
This kind of stuff happens all the time with vehicle repair checks from an insurance company. Technically, it's fraud, but people with a $500 ding learn to live with the ding and go to the mall. Really, unless you're in dire need of this money I'd pay the Dr. in full. But, to each his own. Either way good luck.
   — Kristin R.

October 22, 2001
Rather than depositing the check and writing another, just endorse the back of the check over to the anesthesiologist. That way you won't be tempted to spend the money once it's in your account. You won't miss the money because it was never yours. Shelley
   — Shelley.

October 22, 2001
Don't do it. Regardless of what money problems you are having, don't keep that money. My aunt did the same thing, was charged with insurance fraud. Was sued, and got probation. Now that may not sound bad, but try getting a job with a fraud charge/conviction. Your husband will be the one that will be charged, since the check is made out to him, and you could be an accesory if you sign, or put that check into an account with both your names on it, it isn't worth it. You think you have money troubles now, cash that check and don't pay that doc, you'll be wishing you did.
   — [Anonymous]

October 22, 2001
Processed twice, means that the doctors office is looking for their money, the money you have. They tried getting it twice. If they process again, the insurance company is going to know that you didn't pay them, and then your probably going to get a call from them. that money is not yours! Period. You have no right to keep it. Did you know it's people like you that contemplate or keep money that is not theirs, that makes insurance go up for the rest of us.
   — [Anonymous]

October 22, 2001
It would certainly be nice if you could keep the money and make' a payment arrangement with the anesthesiologist and it wouldn't be illegal. But it certainly isn't the ethical thing to do. The anesthesiologist provided the service and he deserves to be paid... now...just like the surgeon and the hospital. Apparently he didn't get have you "assign" the payment to him...so, the insurer was sent you the check. Do the right thing....pay the man.
   — [Anonymous]

October 22, 2001
I totally disagree with the other posters on this question. For instance, what would happen if the tables were turned around. You paid the bill, then got the check and put it in your bank account, would that be fraud? Don't think so, also I have been in surgeries that the hospital billed for anethesiologist (sp) and the office (billed twice for one anethetic). So as long as you tell them you already filed with insurance and are willing to make payment arrangements I don't see a problem with it. As for fraud, that is not what insurance fraud is. Insurance fraud is claiming you have a back injury and really don't!! If it were fraud, why did the insurance company make the check out to your husband instead of the doc?
   — [Anonymous]

October 22, 2001
This is NOT an unusual circmstance. I work in hospital finance and this happens...too often to suit me. It certainly isn't fraud. It wouldn't even be illegal to keep the check because it is made out to you. But it is wrong...it is unethical. That check was intended for your doc and no matter how you rationalize it...it belongs to him. I'm a little intrigued by the insurer saying the claim was "processed twice". Could be that they paid the anesth. and erroneously sent you a payment also...who knows...maybe. In that case the check should be returned to the insurance company. It's tempting, especially in tough times to keep this money. But you really shouldn't. And let's be honest here, if you did keep, you'd make a few monthly paymets. But, this doctor would never get full payment. That's not right.
   — [Anonymous]

October 22, 2001
I'm posting this anonymously because I know I'll get bashed for saying this. I was in exactly your situation one time. Hard up for money and the hospital filed the claim for me and had the check sent to me because my insurance and the hospital were in debate over their contract. So I got the 800.00 check. I cashed it. I was slow at paying the hospital because like I said I was having money problems.But they got paid and thats all that matters to them anyway. That check got me through on my utilities and rent for a month and to me was worth it. I'm not saying you should cash the check. But I am saying that no one can tell you whether you will pay or not. And don't let anyone make you feel bad by saying it's unethical. Ethical doesn't get the bills paid. And if your doctor is willing to take monthly payments then I say go for it. But make sure the doctor will take monthly payments first.
   — [Anonymous]

October 22, 2001
My previous insurance company would not pay my dentist directly, I was required to pay for services in full at the time of my appointment and then wait around for a reimbursement, sometimes months later. I ran into problems with this after my husband's emergency root canal. We did not have $2500.00 up front and could not pay anything up front. We paid what we could which left us completely broke. We used the insurance money to make up for all the bills we didn't pay. It took several months to pay off the dentist and oral surgeon but we did! The insurance company never called me about any payments, never questioned why we didn't turn 100% of the payment over and no one ever mentioned fraud. The only problem was the receptionist--she became very snotty with our situation and made a big deal about me not immediately turning over the insurance payment and that we would always have to pay for services up front from now on because of our one issue. This may happen to you so think very wisely before you deposit all of the money.
   — [Anonymous]

October 23, 2001
I'm so glad that so many folks think it's ok to keep the money and pay the doc in drips and drabs. Even though no such payment arrangement was discussed *prior* to the doc's providing the service. I'm glad because I do billing for a small dental practice. A semi-retired oral surgeon and his daughter who is a divorced mom and works part-time. The practice really needs the money. So, I'm going to balance bill patients for dental services. We're not supposed to balance bill after receiving our fee schedule payment. But, what the he**, we need the money and if any of the patients complain about what we're doing, we'll pay them back. We don't have a lot of money, but we'll reimburse all of them, a little at time.
   — [Anonymous]

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