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Is this insurance fraud? *edit*

Anonymous
Posted by Anonymous
  • 22 Replies
I had a mole on my back that I wanted removed because it was right on my bra line and would get irritated regularly.

I went to the dermatologist and he said it was a normal mole and he wasn't concerned about it in any way, but for my insurance to pay for it to be removed they had to do a biopsy on it, otherwise it would be considered a cosmetic surgery, which insurance will not cover. If they do a biopsy it is considered a medical procedure and insurance will pay 100%.

So do you think it's insurance fraud to do the biopsy just so insurance will pay for it or do you think a biopsy should be done on all mole removals anyways just to be safe?

My husband and I have differing views on the subject so I'm curious to see what others think.

ETA: I'm not asking if I should have it done or not. The mole is long gone. There was no way I wasn't having it removed.

My question is if you think it's insurance fraud for the dr to only do a biopsy so the insurance will pay for it.
Posted by Anonymous on May. 17, 2015 at 11:07 PM
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Replies (1-10):
Anonymous
by Anonymous 2 on May. 17, 2015 at 11:09 PM
Dr offices recode things all the time. I wouldn't consider it fraud, but it is a bit unethical
wildbruin24
by Bronze Member on May. 17, 2015 at 11:09 PM
I don't feel it's fraud. It's a good idea to have it removed and checked.
heydooney
by Gold Member on May. 17, 2015 at 11:10 PM
I had one just like that removed from my bra line when I was 17. I was under my parents' insurance so I didn't deal with it but the doctor said it's their standard practice to biopsy all moles just in case. I don't see a problem with it.
Uhura
by Platinum Member on May. 17, 2015 at 11:10 PM

It's right on the line..I'd say since it did get irritated with it where it was, not a big deal.

Now if it didn't and it was purely cosmetic..then I'd have more of a problem with it.


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ladyvamp5489
by Platinum Member on May. 17, 2015 at 11:11 PM

i had a mole removed it was right on the bra line on my shoulder and my strap would make it hurt, it was froze off. Not an issue with the state ins. I would do it cuz i know how it feels. 

Anonymous
by Anonymous 4 on May. 17, 2015 at 11:12 PM
The problem is that the dr has to prove that the mole is suspicious for insurance to pay, and even if he submits the paperwork they can deny if they disagree with him.

Insurance has gotten really crappy this past year.

My dr thought I had a stroke and ordered a MRI and insurance said that it was unnecessary BC a different test prior to that showed up negative.
Anonymous
by Anonymous 5 on May. 17, 2015 at 11:14 PM

I'd have the biopsy, even if it isn't malignant, it could turn malignant.

Anonymous
by Anonymous 6 on May. 17, 2015 at 11:15 PM
Insurance companies are a fraud and a rip-off. I say, what's good for the goose......
tapies2324
by Platinum Member on May. 17, 2015 at 11:15 PM
Call it whatever. Have them take it off. For God sake you pay for the insurance...use it.
PinkButterfly66
by Sapphire Member on May. 17, 2015 at 11:15 PM
1 mom liked this

Nope.  The insurance company SHOULD cover shit like that.  If they weren't shuch money grubbing bastards doctors wouldn't have to do creative coding to get it covered.

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