US: Insurance Fraud??

I recently posted in IA about finding doctors that are in my network for my insurance. I called my old dermatologist today to see if they take my insurance. They do not. When I asked how much it would cost to just pay out of pocket, the receptionist replied 'Oh, we can't do that, that's fraud.'

I said 'Really? If I just want to pay out of pocket because you don't take my insurance, I can't do that?'

'No, we can't take out of pocket from someone who has insurance, it's fraud.'

I had no idea about this. Can someone explain it to me? How is it fraud? Would I be the one committing fraud or them? Or both?

I'm just completely baffled! It makes no sense to me!

Never heard of that before. At least in the state of GA, it's not fraud to pay out of pocket even with insurance.

Never heard of that before. At least in the state of GA, it's not fraud to pay out of pocket even with insurance.

I'd never heard of it either! And when I went to an urgent care place a few months ago, they had said to me 'If we don't take your insurance, you'll have to pay the full amount of an appointment.' Is that not the same exact thing?! I felt like I was crazy when the dermatologist's receptionist said this to me.

I'd never heard of it either! And when I went to an urgent care place a few months ago, they had said to me 'If we don't take your insurance, you'll have to pay the full amount of an appointment.' Is that not the same exact thing?! I felt like I was crazy when the dermatologist's receptionist said this to me.

I'm guessing the woman has mixed up some other regulation- like filing with insurance or something?? What state are you in? Maybe use a little google-fu and see if you can't find anything that proves her wrong that you could print out to show her. Sounds like the dr is worth it.

That...makes no sense. I've gone to doctors out of my network before (in NJ with NJ-based insurance and in NY with NJ-based insurance and a friend of mine regularly goes to an out of network doc in NJ with NY based insurance) and paid out of pocket. Depending on your insurance, you might be able to get reimbursed for part of the cost but there's no guarantee. Actually, there's a huge article in the NY Times from like yesterday all about rich people on the UES doing exactly that (because doctors decided to stop taking insurance because it's such a hassle, they don't get enough money, etc so not exactly the same thing but still). That article is here: http://well.blogs.nytimes.com/2012/10/01/when-doctors-stop-taking-insurance/?ref=health

Anyway, sounds like the receptionist has no idea what she's talking about. Also, where is this derm? I've been meaning to go to one for awhile and maybe they take my insurance!