Auto Insurance Claims: Special Investigations Unit, special investigations unit, billing fraud

Question
Recently when my claim was being settled, a special investigations unit adjuster called me questioning the therapy I received from the doctor.  WHy would they question that when they had already got my medical records from the doctor.  I received a letter from the insurance company saying some of the services billed I didn't receive.  How do I know what they billed for?  I like the doctor and sure that he wouldn't do that.  Why would the ins company question this?  Am I responsible for the part of the bill that the insurance company is not going to pay?  Please help.

Answer
Hello Michelle,

Obviously, you don''t know what you are being billed for. You didn't state the type of doctor, but Chiros are commonly under suspicion, because (my opinion) they commonly charge for additional services they did not perform. Mine went to prison for tax evasion and medical billing fraud.
I do not know your situation, but I have experienced where the ins would only pay prevailing rate which was much less than the doctors charged, leaving me responsible for the balance.
SIUs have to justify their jobs, so they review anything that may cost them money.



Rob