My question involves insurance law for the state of: California
I recently had an elective surgery a small part of which qualified for insurance coverage. The doctor required I pay in full in advance, and sign a contract stating I understood this was not a medically insurable procedure. I paid, had the surgery and months later receive a EOB from my provider along with a check from them for a small amount. On the EOB I see that the doctor has submitted a claim for well over 4 times the total amount I paid him.
Has he committed insurance fraud by not disclosing to them the fact that I paid in advance and paid a prearranged price which was around $20,000 less than the claim amount he submitted to them? The doctor is now demanding I send him the insurance check amount - although we had a signed contract and I paid in full prior to the surgery, is he somehow entitled to this insurance check money I received? I called the Drs. office and the billing person was insistent that it was their money and I need to pay them immediately. Am I unwittingly committing insurance fraud if I cash the insurance check? Any thoughts appreciated, Thank-you!