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Monday
Apr102006

How To Run An Insurance Reimbursement Scam & Make Your Patients Hate You.

This has got to be a low point in patient service.

As health insurance costs skyrocket and more people turn to high-deductible policies, a key question is emerging: When you're paying out of your own pocket, what rate do you pay?

Is it a discount negotiated by insurers, or the provider's gross charges, which could be several times higher than the negotiated rate?

Case in point: Lisa Stamm of Kendall, who had a simple earache and got slapped with a $375 bill for about 10 minutes with a nurse practitioner. If she had no insurance, she could have paid $125. If she had a no-deductible policy, her insurer might have paid about $140, and she would have paid nothing.

But Stamm showed the receptionist at ER Urgent Care Center on SW 137th Ave. her Cigna insurance card, and that sparked the problems.

''This really made me mad,'' Stamm says. ``I called the insurance commissioner's office. I called my insurance. You'd think something could be done.''

But no. ER Urgent Care insists she cough up the full $375. ''We as consumers have to make our choices,'' said Trudy Herdocia, the firm's vice president of operations. ``And live by them.''

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