Her Two Cents

This is a pin cushion. It makes sense, I promise.

I’m due with my second child any day now. (So if I suddenly fall off the radar, you know why.) And until a few weeks ago, she was breech. For several weeks, I tried just about everything to get her to turn, including acupuncture, which I’ve never partaken of before. I looked around for a local acupuncture clinic, picked one at random, and made an appointment.

“How much will it cost?” I asked.

They told me it would cost $90 for acupuncture and moxibustion—a practice in which they burn an herb (moxa) down by your pinkie toe. It’s just as odd to have it done as it sounds.

At no point did I consider checking my health insurance benefits to see if they covered this strange procedure, but as I was paying my bill, the practitioner asked me if I had insurance.

I do, I said.

They took a look at my benefits and said, “Oh, your insurer covers acupuncture.”

Really? I said.

The catch: This acupuncture practice was out of network, and I hadn’t hit my out-of-network deductible for the year. In fact, I still had $400+ to go before I hit that. So my insurance would cover acupuncture there—but only after I’d seen these folks at least four times at $90 a pop.

“Don’t worry,” they said. “You pay for this visit, insurance pays for the next one.”

That doesn’t make sense, I thought.

I went back once more for a visit and they told me they’d bill my insurance for the cost. Again, $90. I let them, because I figured that at least the charge would chip away at my deductible, and then they could just bill me for the full visit.

A few days later, I checked my insurance claims. And the acupuncture practice had billed my insurance for two visits: $595 for the first and $395 for the second. They had, in effect, blown right through my out-of-pocket deductible and been reimbursed by my insurance company to the tune of $333.

Let’s revisit. I owed them $90, they billed my insurance company for $990, and they received payment for $333. (Because the first several hundred dollars simply made my deductible disappear.)

I don’t know about you, but that seems like fraud to me.

It also seems like fraud to Carolyn McClanahan, M.D., a financial planner in Jacksonville, Fla. “This problem is very common,” she says. “And the most common fraud is the one you experienced, where people get overbilled for services that were supposedly a lot cheaper or things that weren’t performed.”

In this case, the acupuncturist hasn’t billed me for a cent. Why should he? He’s collected nearly four times his fee from my insurer.

I think I know what the acupuncturist was trying to do. I think he probably thought he was doing me a favor—annihilating my deductible so that subsequent visits would be paid by my insurer. Unfortunately for him, I’m not down with that.

So I called my health insurance company and reported the acupuncturist to the fraud department. I’m very curious to see how it’s handled—or whether anything comes of this at all. Because frankly, I had to jump through some weird hoops to even report the incident, which seems odd, since I’m actually trying to save my insurer money.

Have you ever had an experience like this one?

(Photo from craftapalooza on Flickr.)