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Insurance contacts patient

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ste:
I have been billing for this particular CAM provider for 10 months. A family of three sees this practitioner on a fairly regular basis and I must say the insurance pays better than most. The head of the household recently received a phone call from the insurance telling him that this particular provider is not a doctor, he and his family shouldn't be seeing this provider, the provider isn't covered, and on and on. The insurance went to great lengths to dys the provider and did so in a rather threatening manner.
I have not been contacted by the insurance, the provider has not been contacted by the insurance, and I am at a loss as how to respond. I am not even sure I should respond?
Is this something the state insurance commissioner should hear?
A year ago I had 0. Today, I have 18 and am a bit overwhelmed, but I am having fun. What a difference a year can make.
Steve   

DMK:
JMO but for your peace of mind, if the provider wasn't a provider, the insurance wouldn't pay him!  He has to be registered with NPI, licensed and a verified provider or they wouldn't pay him in the first place!

The provider should contact the insurance company, the patients should report it to higher ups at their insurance company and the insurance commissioner should definitely be notified!

Now I'll show my ignorance....what is a CAM provider?

ste:
CAM = Complementary and Alternative Medicine

ste:
The provider is a bona fide provider with an npi and all the bells and whistles. Provider has been seeing these 3 family members for some time, sending me superbills, I sumit them to the insurance in question, and the insurance has been paying the claims.

PMRNC:
Sounds like an internal investigation is taking place. I would definitely NOT just sit on this and do nothing if you are doing the billing. If you are billing and now have reason or suspicion of wrong doing, you are now JUST as libel. I would definitely contact the insurance company and make an inquiry to get the specifics so you can make a decision for your own liability and as well as educate the provider. It's not uncommon for an insurance company to notify the insured of an investigation pending or otherwise and not inform the provider while doing so..if they continue to pay claims..well then I'm at a loss.  BUT regardless..you have knowledge that something is not right and that puts liability on you from that moment forward. You should probably consult your contract and your own compliance plan and take action in accordance with those things, your compliance plan is important in cases like this as it is (or should be there) to refer to when things like this come up.

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