This weekend I received a letter saying that my request for “Testosterone 1.62% gel pump” was denied. The letter has all my correct information as well as my healthcare member ID correct. My “insurance” is self insured through my company and every dollar the healthcare plan pays out is a dollar to the expense line and a dollar that my company pays. I sent this to the healthcare/claims department to report as potential fraud.
The provider is not someone that I am familiar with. I rarely go to a third party doctor as my work has a onsite clinic that I don’t have to pay to see nor do I need to make an appointment.
My initial though is some provider has been hacked and medical and or billing information has been hacked. Now a fraudster is trying to get money out of the insurance company. It could also be an honest mistake where a provider with multiple doctors got their wires crossed. I don’t know yet but this is going to be a real pain in the ass as my insurance company will likely issue me new ID. It’s not a big deal for me buy my wife sees boat loads of doctors.