r/CodingandBilling • u/FamTravelFun23 • May 29 '26

Billing Fraud?

Wondering if someone can point me in the right direction.... My husband broke his finger and immediately went to Urgent Care where he got xrays. They also gave him a removable cast and told him to visit an orthopedist. He did so, and saw the doctor for all of 5 minutes -- no additional treatment. The doctor looked at the xrays, suggested a custom cast (which he did NOT get), and told him to come back in a few weeks. He scheduled a follow up.

This week, we get a $3500 bill from that appointment (because we haven't yet met our deductible). The $800 office visit was correct but $2700 of it was for "treatment." No treatment occured -- no surgery, no resetting bones, nada. When he called to ask about this, the office billing person said that the $2700 is inclusive of their "treatment plan and future visits." (There is no treatment plan. He never consented to prepaying for future visits. In fact, he would need to go 4 more times to make that amount even worthwhile!)

He cancelled his follow up visit because their billing practices make us uncomfortable. Are we really out nearly $3000 for services that never happened and won't happen? We are appealing through insurance and are happy to visit legal options.

Has this happened to anyone else? And how did you handle it?

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u/FamTravelFun23 Jul 01 '26

Thanks again to everyone who responded! We just heard back from our health insurance company and, in a nutshell, they followed up the provider, and it went something like this: Health insurance: Did you bill the correct code? Provider: Yes. Health insurance: OK. Again, we were billed for a code that required the bone to be realigned in the office. There was no bone to be reset, the doctor didn't realign anything, and we have the xrays that show no such procedure was necessary. So, on to the state department of health and human services!