I just had the most unbelievably surreal online chat with my uncle’s insurance company, Healthfirst. I was trying to report to the insurance company the fact that someone appears to be billing them for care that was not actually provided to my uncle. Here’s how that went:
[NOTE: There’s an update below the chat transcript.]
Welcome to the Member Services Chat! To protect your personal information, please do not enter sensitive details about your health, bank or credit card details in chat. Please do not leave this screen or your session will end.
How can we help you today? Please type your response below.
I am suspicious that some claims may be erroneous or fraudulent.
Thank you for responding. An agent will join shortly. If your contact information changed in the last 30 days, please notify your Service Agent. If chat disconnects, feel free to reconnect for assistance.
Hi, [name]. Thank you for being a Healthfirst member. My name is [name], and I’m happy to help you today with the claims inquiry.
May I have the Date of service and name of provider please?
Hello. This is not [name], this is his nephew Jonathan Kamens. I am listed in your system as being authorized to speak with you about my uncle’s care.
There are four claims from provider “[name]” dated 06/30/2025, 08/03/2025, 10/02/2025, and 02/02/2026.
To my knowledge my uncle is not receiving any treatment from this doctor.
I called the phone number listed on one of the claims, and while that is indeed a medical practice, they do not have my uncle listed as a patient.
I asked if they have a doctor by that name at their practice, and they said he “occasionally uses their office” to see patients, but is not actually a member of their practice, so that’s also pretty odd.
I understand. However, all the dates of service have no associated claims. Please ask the provider to send those claims over for processing.
I don’t understand what you just said.
First of all, I can SEE the claims RIGHT NOW in your system on the dates I specified.
I mean the claims for the date of service listed are not on his account from what I see.
Here are the claim numbers: [four claim numbers]
Those are four claims I see in your system for the dates I gave you under the provider [name].
The other thing I don’t understand about what you just said to me is why would I “ask the provider” to submit the claims to you for processing when I just told you I believe these claims are erroneous or fraudulent.
I’m reporting LIKELY INSURANCE FRAUD to you and asking you to look into that.
Alright so just to confirm your uncle did not have the service?
I am not aware of my uncle having been treated by that provider on the indicated dates or any other date.
I am very much in the loop for my uncle’s medical care.
I suppose it is possible that there is something I do not understand here and these claims are legitimate.
That is why I am asking you to look into it.
At the very least there is something quite wrong with the fact that these claims are being submitted from a provider address and phone number for a practice the doctor is not a member of.
Thank you for providing that information.
Claim [number] is pending. [number] is not showing in system. Same for [number] and [number].
Let’s wait for the claims department to complete their processing and would be advised of further action if any.
I will leave a note on the account to have this documented.
I don’t understand what’s happening here.
I don’t understand why you are telling me you can’t see those claims in your system when I can see them in front of me on your website right now as I am typing this.
I don’t want to wait for the claims department to complete their processing.
I want you to notify whichever department in your company is responsible for investigating potentially fraudulent claims that you’ve received a report that these claims are potentially fraudulent.
Have you received a bill?
Jesus
Is there someone there I can speak with who has a clue?
You know what, never mind.
I’m sorry for trying to do a good deed.
Just forget about it.
Sheesh.
UPDATE: Someone from Healthfirst called me about this later on the day I had the chat conversation above. I missed their call, but they called back the next day and I spent 15 minutes on the phone with them.
Most of the 15 minutes consisted of me telling them what information I was seeing about the suspicious claims in Healthfirst’s own member portal. Yes, really, I had to read the information off my screen to him.
I said at one point, “I’m confused. Why are you asking me to read this information to you? Surely you have access to all the same information about claims that I can see in the portal?”
He said yes, he does, but there’s a “discrepancy” between the information he’s seeing and the information I’m seeing. Apparently on his end, the dates of service were all one day later than what I was seeing in the portal. I tried to explain to him that this certainly didn’t reflect a discrepancy in the claims filed by the physician, but rather some sort of bug in Healthfirst’s computer systems, and he was completely incapable of grasping this seemingly obvious fact. Instead, he had to waste more of my time.
Then he informed me in order or me to be able to file a grievance about these claims on my uncle’s behalf, I would have to get my uncle to sign an “Appointment of Representative” form allowing me to represent him.
I replied, “Hold on. I have no desire to file a grievance or engage in any other sort of bureaucratic time-wasting about this problem. These claims don’t impact my uncle at all. He hasn’t lost any money because of them. This is entirely a Healthfirst problem. I notified you about the suspicious claims because that was the right thing to do, and surely you should want to investigate them regardless of whether I file a ‘grievance’.”
In short, they wasted another 15 minutes of my time for no real purpose, but perhaps they’re actually going to investigate the claims, so that’s something, anyway.
