OT: kicked out of ped practice

[PA Princess]

I am looking for advice to offer my sister on a situation she finds herself in. She has a 10 year old son who has adhd and she is currently pregnant with another baby. Pregnancy is her third baby...middle baby died at 6 weeks from SIDS 5 years ago.

Anyway, she picked up her older son's prescription at the ped, noticed it was only a 7 day supply, and called to ask why? The billing person not so nicely informed her that they were being kicked out of the practice for not paying a past due bill. Dn had stitches removed last August and there was apparently a $6 bill left over after insurance was paid.

My sister said she really just somehow missed the bill. She had dn to the ped in February for a well check, and at that time paid $20 (she initiated payment because she said her insurance never covered the hearing test given and she did not want to forget about the bill). No mention of this $6 was ever made at that time.

By the time I talked to her today she was pretty hysterical (8 months pregnant and it does not take a whole lot). Her son's adhd history is with this ped, and with the new baby and the SIDS history and all she does not want to look for a new ped. Can anyone offer advice on how she should proceed?

She said they would not even let her pay the bill today (went to collections, so they cannot take payment is what she was told). Plus, her son will have no medication in a week, but they outsource to some other company the medical records and she was told it will take several weeks for the records (and a $25 handling fee) to be transferred. How would she even begin to get a new doc and get the meds her child needs without records???

My sister works full time, she's a newly single mom, and she is having a challenging pregnancy. She is a great mom, but she is often scattered when it comes to details (well personal...not at work). She is a well paid professional, so it is not an issue of affording the bill (though it is $6 for pete's sake).

I have no idea what advice to give her. I decided to ask the people here, because there are so many with varied experiences that I thought someone may be able to shed some insight or offer good advice. Thanks to anyone who can help.

 

[vafarmmom]

wow that is rough. If she has a good relationship with the doc I would try to talk with him. My son's ped's office was very rude to me and screwed up some billing stuff and I ended up talking to the dr and it made a world of difference. Not sure how she would be able to get through to him/her, but I would try and also try to talk to an office manager or something if she hasn't already. Maybe call the insurance company too - in the same situation a rep from my insurance intervened and it helped alot too.

 

[kyhardy]

wow that is rough. If she has a good relationship with the doc I would try to talk with him. My son's ped's office was very rude to me and screwed up some billing stuff and I ended up talking to the dr and it made a world of difference. Not sure how she would be able to get through to him/her, but I would try and also try to talk to an office manager or something if she hasn't already. Maybe call the insurance company too - in the same situation a rep from my insurance intervened and it helped alot too.

I second all of the above. I work in the medical field and know that most Dr's wouldn't go to this extreme over something so small. If the above doesn't work I would suggest that she contact the State Medical Board.

1. A physician is required to provide a patient with 1 free copy of their medical records.

2. When dismissing a patient from the practice the physician is required to provide medical treatment for emergency type issues and medication refills for 30days. This is to allow you time to find another physician. They also have to notify you in writing, we send certified mail, not sure if this is required though. Without doing these things the physician can be accused of abandonment of care, which is a serious charge.

If no success with the Dr. I would suggest she inform them she is contacting the State Board and tell them the reasons above. Maybe that will inspire them to have a change of heart. However, if it takes these measures to resolve the issue she'd be better off with a new Ped.

 

[TBGOES2DISNEY]

She could try calling the doctor's after hours number and explaining to him. They usually answer their own calls (unless they're in a group of doctors for after hours). If he's a nice guy, he'll care. If not, it's time for a new doctor.

 

[Erin1700]

Hey, I notice you are from PA, is your sister as from here as well?

At our peds, if you get turned into collections, they will not do well visits for your child unless it is paid. Once she gets the bill from collections, and pays the 6 bucks, can she take the kids back there?

I agree to talk to someone else at the office.

 

[Maggie'sMom]

I'm not as versed in the laws as kyhardy, but I do know that the doctor has an obligation to give a reasonable amount of time for the patient to find a new doctor. Have your sister contact the office tomorrow and ask to speak to the doctor. If she is unsuccessful in that, have her contact the state medical board. They should be able to give her guidance as to how to proceed from there. If she has a good relationship with the doctor, he won't want to see her have to find a new doctor all over a $6 bill.

 

[scjo68]

I feel for her. I agree with vafarmmom that if she can actually talk to the doctor, that may help. Generally, I think the doctors have very little knowledge of the office management/ billing. It's probably hard to get to the actual DR, though, the office people are quite the gatekeepers. Most Doctors I've dealt with have their own nurse who I can usually ask for directly and at least get put through to the nurse or their specific voicemail. In fact, I often don't even have to ID myself to the person answering the phone to get connected to the nurse. So maybe she could call and ask to speak to "Dr Whoever's nurse", or even ask for her (or him) by name. Let the nurse know what's going on, and they will almost certainly tell the doctor.

I agree about seeing if the insurance company can help- but it probably depends on the insurance. Something similar happened to me and the insurance company just took care of it. I'd had several surgeries and spent a couple of weeks in the hospital, and had received care from doctors in a couple of different practices. Of course the bills trickled in later, and we paid whatever insurance didn't. At least a year later, I got a bill from a collection agency, with only the date of service, which was during my hospital stay. But, there was no doctor's name, no procedure name or code- nothing. Just a relatively small amount that I owed. I called both practices to find out which doctor I owed, but neither had any record of my balance. As you said, once it goes to collections, they have nothing else to do with it. I told both doctors' offices I certainly wanted to pay the doctors whatever I owed them, but I had no desire to pay this collection agency I'd never heard of.

While I don't claim to be very organized about bills and book-keeping, my Dh is extremely good about this, and he had records of every bill/statement/ payment, and there was nothing to indicate we'd missed a payment.

So, I called the insurance company, and they took care of it somehow, in a matter of minutes.

Other thoughts; if she does need a new ped., a good resource might be other parents she knows with kids with adhd.

I can't imagine that they can refuse to give her the medical records. I would be really interested what a lawyer would have to say about that.

 

[bumbershoot]

"
1. A physician is required to provide a patient with 1 free copy of their medical records. "

That's not exactly right according to what I know about it. They are required to give another doctor, directly or through the patient that's up to the former doctor, the records required for continued care. That's it.

They are allowed to charge a "reasonable" fee for the records beyond what they deem needed for continued care.


OP, your sister might think she wants to keep seeing this person, but she doesn't, not really. This office is rude, doesn't communicate, and doesn't seem to know what it's doing. Not a place I'd trust with such delicate issues as her family has!

Surely she knows people who have different peds. She could ask her midwife or OB if they have any suggestions. And after finding a new ped, have that ped request the records from the old doc. Bet it'll be a different story for the new doc than it would be for the scenario of the patient leaving with the records...

 

[kyhardy]

"
1. A physician is required to provide a patient with 1 free copy of their medical records. "

That's not exactly right according to what I know about it. They are required to give another doctor, directly or through the patient that's up to the former doctor, the records required for continued care. That's it.

They are allowed to charge a "reasonable" fee for the records beyond what they deem needed for continued care.

No - Dr must provide patient 1st copy free of charge, they may charge for any subsequent copies requested by pt. This does not apply to requests from lawyers, insurance co. etc. A Physician can charge for all copies they request. The physician is required to maintain the physical file, but a patient has a right to the information contained within it at any time.

 

[camlace]

No - Dr must provide patient 1st copy free of charge, they may charge for any subsequent copies requested by pt. This does not apply to requests from lawyers, insurance co. etc. A Physician can charge for all copies they request. The physician is required to maintain the physical file, but a patient has a right to the information contained within it at any time.

Does this vary by state? I have changed my primary care doctor as well as OB/GYN in the past view years and both times I was charged for copies of my records, even after putting up a fight

 

[Tink-aholic]

No - Dr must provide patient 1st copy free of charge, they may charge for any subsequent copies requested by pt. This does not apply to requests from lawyers, insurance co. etc. A Physician can charge for all copies they request. The physician is required to maintain the physical file, but a patient has a right to the information contained within it at any time.

Sorry to say, but this is not accurate. Bumbershot is correct. A doctor can charge a reasonable fee for the copying, compliation, and certification of medical records if they are not going to another doctor or to an insurance company. Many don't charge out of simple courtesy to the patient, so that may be where kyhardy is confused. They can (and frequently do) charge a significantly higher fee when lawyers are requesting records.

Also, the patient is not entitled to any information in their chart at any time. The chart belongs to the doctor and can provide copies (at a fee, of course) to patients with a reasonable amount of notice. They do not have to provide labwork, pathology reports, or any documentation that is not generated within their office (including any past records sent to them by previous doctors). They can also mark your current chart (page 1 of 50, page 2 of 50, etc) in order to make certain that you don't remove any information before sending it on to the next doctor.

Perhaps kyhardy is thinking about HIPAA, by which patients are entitled to one free copy of the accounting of HIPAA violations in their chart per year under Federal law?

That being said, the discharge of your nephew was not legal. They need written termination and a minimum of 30 days from receipt of that written termination of emergency care. Many states require the discharging doctor to provide the names and contact information of at least two other providers to the discharged patient.

In my opinion, any doctor who would dump a patient over $6.00 is not worth it. It is possible that this doctor was looking to discharge this patient and is using this as an excuse. Either way, I think your sister should be looking for a new doctor. It doesn't have to be a pediatrician, either.

Good luck.

 

[RobinFabulous]

What a hard situation. SPeaking from experience with an ADHD child, I would start looking for other peds offices. We swapped after my daughter was diagnosed and on medication b/c they were slow to respond to my second childs extra needs and it was the best thing that ever happened.


Start calling around for her and try to seek out advice from other parents you know. I would not want to take my child back to a practice that had treated me like this. When she goes to the next dr have her take all the medication and a good ped would do a refill why he waited for the records.

 

[pweyl36]

Sorry to say, but this is not accurate. Bumbershot is correct. A doctor can charge a reasonable fee for the copying, compliation, and certification of medical records if they are not going to another doctor or to an insurance company. Many don't charge out of simple courtesy to the patient, so that may be where kyhardy is confused. They can (and frequently do) charge a significantly higher fee when lawyers are requesting records.

Also, the patient is not entitled to any information in their chart at any time. The chart belongs to the doctor and can provide copies (at a fee, of course) to patients with a reasonable amount of notice. They do not have to provide labwork, pathology reports, or any documentation that is not generated within their office (including any past records sent to them by previous doctors). They can also mark your current chart (page 1 of 50, page 2 of 50, etc) in order to make certain that you don't remove any information before sending it on to the next doctor.

Perhaps kyhardy is thinking about HIPAA, by which patients are entitled to one free copy of the accounting of HIPAA violations in their chart per year under Federal law?

That being said, the discharge of your nephew was not legal. They need written termination and a minimum of 30 days from receipt of that written termination of emergency care. Many states require the discharging doctor to provide the names and contact information of at least two other providers to the discharged patient.

In my opinion, any doctor who would dump a patient over $6.00 is not worth it. It is possible that this doctor was looking to discharge this patient and is using this as an excuse. Either way, I think your sister should be looking for a new doctor. It doesn't have to be a pediatrician, either.

Good luck.

I was just going to say the same thing,I work for a dr and pt aways think that the charts are theirs. Its accually the drs property.We somethimes discharge pt but you have to send a certified letter and then you have 30 days to find a new dr. Your sister should talk w/the office manager,because being let go for $6 dollars is crazy. If we have a pt thats in collections then they must pay be for being seen.

 

[Miz Diz]

I would want to switch doctors after all this.

I find it very odd that they would send a $6 bill to collections because this is not cost effective for the collector. It will cost them much more than that. Maybe there is more to the story?

 

[mom2aredhead]

I would venture to guess there is more to it than the $6.00 bill that caused the paractice to make this decision.

 

[Chokky]

I agree...for whatever reason it would seem the Practice no longer wants them as a patient.
Our dentist often doesn't bother contacting us for the $4-$5 that our insurance doesn't end up covering and just eats the charge.
I often ask them about it when I get the actual bill copy but they say not to worry about it.

 

[thegrimdwarf]

I would venture to guess there is more to it than the $6.00 bill that caused the paractice to make this decision.

I agree. If your sister is scatter-brained, as you said, I'm sure this isn't the first time she's been challenging for the billing department. I used to manage the billing department for a large metro hospital, and I can honestly say that chasing down payments - no matter the amount - is more trouble than it's worth for doctors, but they are required to do so or they are in violation of their contracts with the insurance companies. So if your sister habitually requires chasing down to resolve an account, I can easily see why future care would be denied - especially in a small practice.

Also - regarding records for free - the patient is not entitled to a free copy, in any state. Medical records and x-rays are the property of the doctor. A doctor or practice may elect to supply a free copy to a patient, but is not obligated. A free copy will generally be forwarded directly to another provider as a matter of professional courtesy, if a written request and release is on file.

I would suggest you tell your sister to immediately look for another doctor for her son, and to get better control over her responsibilities. It will be a pain to find a new doctor so quickly, but I can tell you from being on the doctor's side for so long - she will find the staff less than helpful if she remains at this practice. She needs to make other arrangements.

 

[dananbethany]

I worked for a doctor's office for 7 years and we never, ever, ever kicked anyone out for not paying a bill. In fact, we have signs posted up that it is the law that we cannot refuse to see anyone for not paying their bill. Heck, we had people owing several thousands of dollars come in and we had to see them, knowing we would never get our money. I'm not one to always advocate calling a lawyer, but call a lawyer.

 

[PA Princess]

OP here, thanks everyone for all of the advice....exactly the different points of view I was seeking!

My first instinct was absolutely to find a new doctor. This is not the first thing I have scratched my head over that she has told me, but this is a very large and popular practice in our area and sis seemed so determined to try and stay. I wondered if I was over reacting.

As some pointed out, I realize that there may be other issues that I am not aware of. I do know that my sister was behind on her bill last year over the hearing test, that is why she paid at the visit this year. I really think it is ridiculous they did not mention that $6 at that point in February.

As for being responsible, you know everyone of us falls on some level of the responsible spectrum. I am the oldest, type A, super planner, uber responsible...always have been and probably always will be.

My sister is an adult with unmedicated adhd and being on top of these types of things is certainly a challenge for her under normal circumstances and extra hard currently. But I love her dearly and my heart just ached for her. I did not want to let my feelings give her wrong advice, so I sought advice here knowing there would be some who would give it to me straight - thank you.

My sister called a nurse we know personally (an old family friend) and that nurse said she would do some checking to see if things could be smoothed out. Sister is content with this, but she is also looking at other doctors (something I really encouraged her to do). I will let you all know what happens.

 

[KibbyCat]

I'm not sure why the office staff would tell her that once it went to collection, they could not accept payment. Drs.offices and hospitals are quick to send bills to collection when unpaid for a certain amount of time, even if the person who owes doesn't know about the charge. After my baby was born, I was sent to collections for missing a minimum payment on my hospital payment agreement. I didn't know I'd missed, but nobody called. I only found out AFTER being sent to collctions, and AFTER my credit was messed with. Furious, I called the hospital and was informed that they had never received my check. I refused to pay the collection agency, so I called my bank, had payment on my check stopped (luckily it hadn't been cashed), and wrote a new check to the hospital. After a couple months, someone at the collections agency called me saying that the hospital had decided to settle my account at a reduced rate if I'd pay the remaining balance that day. I went ahead and paid since I was saving a ton over the original balance. But, after my experience, I thought it strange what you said about them refusing to let your sister pay her $6. Maybe dr. offices have different policies than hospitals? If I were her, I'd definitely call insurance. Tell her to ask for written confirmation that they paid but that a balance remained on the account. Then, I'd just go ahead and mail the office a $6 check. But if she doesn't have 2-part checks, she should make a xerox copy of her check before mailing it so that she has proof of payment. Hope that helps!