OT: What to do about this doctor's office

[wdwfamilyinIL]

I am only asking this here, because of all the great advice I have seen given, and not to mention I really don't know what to do.

Here is the situation. I went to a dermatologist last November, for some skin rashes that I had breaking out. Was there about an hour, he asked questions about everything, and who had what in my family. He said that he wanted to do some blood work. When his nurse came in, I asked what test he was having done. She stated a CBC, I thought that 4 vials of blood was a bit much for just one test, so I again asked what test was being done, she again stated the only test that was ordered and that she knew of was the CBC. She stated that the lab needed that much blood. I didn't really think about anything after that, and a couple of weeks ago I received an EOB from my insurance company that showed the lab charges at over 800.00. I thought this was a bit much for just one test, so I then called and asked for a copy of my labs. I received three pages of labs, none of which were ever told to me prior to being ran. Also on top of that the one test that I was told was being ran was not on there, when I asked what happened to the CBC results I was told I had already had one done. To date I have no idea where this information came from, other than it was not from my health records.
I don't feel that it is right that we should have to pay for these charges, since we were only told about the one test. When I told the lab this, we were informed that we had to pay the charges or be turned over to collections. I brought up the fact that we asked several times about the test's being done, and each time the nurse stated only the one test. The lab then stated that the nurse had contacted them, and stated that she did fully inform me of what test were being ran. This is not true, and if it has been documented...it's false.
I have never been in a situation like this, and I don't know what to do. We have tried to phone the doctor's office, and have sent letters.....we never receive a reply.
Does anyone know what type of options I have, I don't feel that this is right for a doctors office to go behind someone's back like this. Please help.

 

[Mouse House Mama]

Send them a letter threatening legal action. I bet you get a response then.

 

[wdwfamilyinIL]

I thought about that, but do I have grounds? The legal system is something totally new to me, I am in nursing school....I just know that treating your patients like this is wrong, and if nothing else a violation of the ana code of ethics.

 

[rt2dz]

Follow your insurance companies policy on disputing bills/appeals. I guarantee you that they have policies in place for false claims. Explain to them that you had no knowledge of these tests being run and you did not authorize them; the only test you authorized was the CBC.

Next, send a letter to the doctors office complaining about what they did. Tell them you do not approve. If they are unwilling to correct the situation (since they are the ones who actually contracted the lab) that you will be reporting the doctor and his entire practice to AMA. Give them a copy of the letter sent to the insuriance agency.

Lastly, send a letter to the lab saying you never authorized any such tests to be run and you would like a copy of any paperwork with your supposed signature authorizing these tests. Tell them that you suggest they contact the doctor who did contract their services for billing. Include a copy of your letter to the insuriance agency.

Be sure to put ALL correspondence in writing and keep a copy. It might also be wise to require delivery confirmation from the post office. If they send a collection agency after you, send a copy of all your correspondence. Tell them you are disputing the charges and attach a copy of that letter and all other correspondence to your credit report IF it shows up there (a lot of times it won't). Dispute the bill to the credit agency if necessary. And whatever you do, stick to your guns. Don't let anyone scare you into anything. If what you say is true, in time you'll win.

 

[wdwfamilyinIL]

I have contacted my insurance company, and right now they are requesting office notes from the doctor. When I talked with the lab, I was told that they don't require patients to sign for services, I did sign the consent for treatment for the doctor, but I never thought that something like this would happen. I have sent two letters to the doctor complaining/asking for an explanation of what is going on, and no reply. The lab was supposed to call me back after they talked with the dr office, no reply. I will not talk with the doctor's office on the phone, and I have a copy of both letters I have sent to them....I wish now I would have thought to send certified mail. I have not sent the lab a letter, that was a phone converstation. I also was on the phone with the insurance company.
So from what I understand I need to send certified letters to the lab and doctors office? Or should I wait on the insurance company to see what they have found out? How do you report a doctor to the ama, for some reason they don't teach us this in school.
Thanks again to everyone.

 

[pamjb]

I agree with rt2dz about contacting the insurance company. All health insurers have policies in place to deal with possible fraud. In addition, make sure you note the names of all of the people that you talk to on the phone. It can be added into the documentation that you are already collecting.

 

[rt2dz]

So from what I understand I need to send certified letters to the lab and doctors office? Or should I wait on the insurance company to see what they have found out? How do you report a doctor to the ama, for some reason they don't teach us this in school.
Thanks again to everyone.

Put EVERYTHING in writing. Do not depend on phone conversations because that can give plausable deniability. Although do take notes on the conversation & be sure to write down all names, date & time.

You can request delivery confirmation without having to send certified mail. Certified mail requires a signature &, possibly, pick up at the post office which they might not do. Delivery certification is where the mail delevery person rips off a tag as they put it in the mailbox/inbox/hands of the person collecting mail (depending on what their mail delevery system is). It's cheaper too. Certified though is definetly much more reliable (ETA--they can't deny it). Don't really expect anyone to answer you, call you back. They might, but most likely they'll keep billing you or just drop it. Can you tell I've been through something similiar?

Personally, I would send the letters to both the doctor & the lab and wait to see what the insuriance company comes up with before going further. If things aren't going well, you might need to get an attorny, but for the most part, the insurance company will handle the bulk of that.

As far as reporting the doctor, go to the AMA website. They used to have a how to file complaints section/information on there.

 

[iamsorcerermickey]

PM sent

Karen

 

[Elliott]

Depending upon which state you live in the state medical board handles complaints against physicians, usually by requiring the Dr to respond to the charges and then taking both sides into consideration and making a judgement. A warning may be given to the Dr if they were in the wrong and if enough complaints or if anything illegal is uncovered it may inhibit the Drs ability to renew his state medical liscense.

 

[ohiominnie]

Something to keep in mind....a squeaky wheel gets the grease.

Call the docs office every day if you have to.

My mom also used to tell me "act like a broken record." Don't get into a big argument with them....just keep restating the facts "I did not authorize this labwork and I will not be held financially liable for it." When they try to go a different route, just say "I did not authorize this labwork and I will not be held financially liable for it."

It really ticks them off that they can't rile you up and wear you down!

 

[wdwfamilyinIL]

Everything just seems to go from bad to worse. I was hoping that the insurance company would get somewhere, but when the nurse called them back she just continued the lies. She is stating that her and the doctor both sat down, and fully discussed everything, and that I had oked the tests. Which is a complete lie, but the insurance company stated that I had no way to prove that there documentation is false, so there is nothing they can do. When I told the lab that I didn't authorize these tests, I was told that they don't require pt auth, and will do whatever tests the doctors order. I did find an email link on the ama website for ethical violations, and did send an email, so hopefully somewhere, something gets done.

 

[seashoreCM]

Why is the insurance company refusing to pay the bill?

What items are you supposed to clear with the insurance company in advance?

Is this an HMO or just a plain insurance company? At least with HMO's you have a primary care physician who tells you when to see a specialist and I suppose who also tells you what kinds of tests and exams and procedures to get.

Disney hints:
http://members.aol.com/ajaynejr/disney.htm

 

[rt2dz]

Repeat all letters in writing to everyone, get them notorized and use delevery confirmation/certified mail. Add to the insurance company that they are free to pay the bill if they choose (it is their money), but that you DID NOT explain the tests or even say when you specifically asked that they were going to be done.

Written letters get much more notice and are taken much more seriously than phone calls. The notorization helps them know you are serious & are swearing to the truth; it will also set you up for denying anything that may or may not go to your credit report--and if the sue you, it's much more legal. Same goes with the delivery confirmation/certified mail (Keep those receipts!!).

The most things that they expect is that you will get tired of fighting and give in. Don't. When I had my problems with hospital billing, it took 16 months, but in the end, I won. It's not fun, it's a lot of work, but when you're right, you're right. It's funny, as soon as someone truly took the time (in my case) to go over the paperwork, I was found to be right.

 

[wdwfamilyinIL]

I am trying to think of anything I can do. It was a real letdown that the insurance company couldn't help me. I have sent 3 emails to address that I found on the ama site dealing with ethical violations. I also filed a consumer complainent with the IN atty general. I have sent letters to the doctor's office, but they don't respond....Even if nothing else happens I plan to be a pain in their side for a while, hopefully it will make them think twice before doing this to anyone else. Thanks again for all of the replies.

 

[Not so Dumbo]

I think a CBC is a whole work up of various blood tests, not just one specific test. Ask your doc again which specific test was done and what it was supposed to detect.

 

[scouthawkk]

I think a CBC is a whole work up of various blood tests, not just one specific test. Ask your doc again which specific test was done and what it was supposed to detect.

Yes, a CBC is a work up of various blood tests and counts. My doc took 3 vials of blood at the beginning of January for mine. And when DS4 had to have a CBS back in September, he was also milked for 3 vials (poor thing). Haven't ever seen results from my tests, but I did see the CBC results for DS's...it was over 3 pages long. Can't help on the $800 cost. My insurance pays for blood work every year. There was one year that I had it done twice within a 365 day period (like just a few days shy of the one year mark) and I did get the lab bill for that, but is was no where near that high. Like $200 or something, I think.

 

[Savanah'sMom]

Hey, I found this on Web MD, http://www.webmd.com/hw/lab_tests/hw4260.asp , It explains what a CBC is. Don't know if it will help much but I figured I would just offer the info. Good luck with everything and I hope it's over soon.

 

[CleveRocks]

Yes, a CBC is a work up of various blood tests and counts. My doc took 3 vials of blood at the beginning of January for mine. And when DS4 had to have a CBS back in September, he was also milked for 3 vials (poor thing). Haven't ever seen results from my tests, but I did see the CBC results for DS's...it was over 3 pages long.

A 3-page lab report contained much more than just values from a CBC.

A CBC measures blood components, and there aren't too many of them (red cells, white cells, hemoglobin, etc.). Other blood tests may look at other materials that are transported by blood (liver enzymes, heart enzymes, lipids, various hormones, medications, the list could go on for days ... ) but a COMPLETE BLOOD COUNT measures only native blood tissue/components, not other stuff that the blood carries.

In speaking directly with the physician's office, I would use the term "bad faith." Tell them you know they are acting in bad faith, and that you will contact an attorney. Of course, don't say it unless you mean it!

You won't get any relief from the lab, because they were just following orders.

Is there any possibility that the physician has an yfinancial stake in the lab? This is illegal in many states. Where it isn't illegal, it's definitely slimy.

 

[Kuffam]

I think a CBC is a whole work up of various blood tests, not just one specific test. Ask your doc again which specific test was done and what it was supposed to detect.

A CBC is "Complete Blood Count" and is one specific test. Other blood test sometimes require the blood to be drawn in a different tube (because what is in the tube). Some establishments when collecting blood, will draw blood using all these different tubes. Therefore if the doctor needs some additional tests, it can be run quickly and without having to restick the patient (and who wants to get stuck with a needle againe).

I would think if the doctor orded the tests and recieved the results, it would not be considered fraud (since they are billing for services rendered). The insurance co. (or patient if paying out of pocket) could dispute the charge as being not medically necessary. I would say, make an appointment (face to face is sometimes best for getting results) with the doctor and find out what tests were done, why he needed them, and what do they mean for you.

I hope this can be resolved for you, I feel people are so quick to run to lawyers these days because health care in is being painted as this incompetent, money hungry, self-serving enterprise; in reality we're all hard working people trying to the best job we can to help poeple.

 

[wdwfamilyinIL]

While the doctor ordered the test's it was all done behind my back. I had asked what they were going to do, and only a cbc was ever told to me, I even made a point to state that if they decided they needed more test's to contact me first since I was seeing a primary for other concerns. No contact, and three pages of labs later here I am.
Normally I am a fairly healthy person, a little overweight, some past thyroid problems, IBS,and sinus problems. My primary doctor was taking care of the thyroid, and I had several tests already done on that, even had a mri to rule out pituitary problems. I went to this doctor for a rash, and skin itching....that is it.
I will list the labs, and this is where I became upset. He ran an RA factor, anaw, ata(which is a thryoid test I had already had done), sjob(included ss a ab and ss b ab), antipc ab/parietal cell ab, prolactin, tsh(which again I had already had this test done 3 times), vit b-12, testosterone, and a cmp. The cmp is the only test I can give this doctor credit for, since it should aslo be done rountinely. I don't know where he came up with some of this, and I am unable to get any type of explanation from him. While I do have a relative here or there that has some of the diseases associated with the lab work, I myself have no signs and syptoms of the actual disease.
Not to mention I was told the cbc wasn't ran because I had already had one, I had one back in 2003 but not since then. I also receive no answers to where this information came from.