Over-billing insurance consequences for DSM

$51.4 million was awarded to Aetna Life Insurance Co. by Humble Surgical Hospital due to the hospitals excessive health care fees.  The judgment was signed last week by U.S. District Judge Lynn Hughes.  
An example of the overcharging was an out-patient fee for ear wax removal, for example, was nearly $100,000. There was many more over charges since 2012 in the suit. Aetna accused them of offering discounts to attract patients, then offering the patients "sidebar deals".    

These Sidebar deals benefited the surgical center by over charging the insurance and writing off the balance for the patient so they could advertise lower fees and attract patients. This same surgical center had a ruling in their favor against Cigna Insurance for the same thing.

What does this mean to us dentists?  This is an example of a very grey practice of over-billing and writing off procedures. This is why we need to identify our patients that are on financial hardships and document this. We also need to attempt to collect balances for patients that are out of network and have not paid the full amount beyond what the insurance pays.


On another note, a federal judge blocked the merger of Anthem and Cigna. We will continue to watch where this goes.