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If your provider offers to "waive" your penalties and/or deductibles...

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    If your provider offers to "waive" your penalties and/or deductibles...

    For out of network facilities and hospitals, you might be offered by them to "waive" your out of network fees, penalties, and deductibles if you seek care from them.

    This is very common practice among physician-owned facilities: The physician wants to induce you to have surgery from him at "his" facility so that he can profit, so he tells the business office to waive your out-of-network penalties.

    THIS IS INSURANCE FRAUD AND IS ILLEGAL. Don't fall for it. It could land you in big trouble. And a doctor who promotes this activity is on borrowed time. You might ask "why?"

    Here is why it is fraud, and who is damaged:

    Hospital A has a contract with your insurance company to do a neck fusion for $30,000 a case. When you go there, you pay your $2000 out of pocket, and the insurance pays the remaining $28,000.

    Hospital B DOES NOT have a contract with your insurance company, but your doctor refers you there because he owns it or prefers it, and they "waive" your $4000 out of network deductible and reduce it to $2000. Then they send your insurance company a bill for the procedure - except they charged $100,000 for it, and expect the insurance company to pay all of it except for $4000.

    So the insurance company is damaged to the tune of as much as $68,000 for the out-of-network "waiver" by the hospital.

    As a patient, you DO NOT want to get caught up in one of these disputes. It's messy. Go to your in-network provider. There are EXCEPTIONS to this that I will outline later.
    Never underestimate the power of stupid people in large groups.

    -George Carlin
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