OT: What to do about this doctor's office

[emma'smom]

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, this is true. I've had four vials of blood taken for a CBC as well. It is a whole work up of under one name. The nurse probably told you the truth...that you were havoing a CBC test done and this counts as one test. She should have explained that the CBC work-up is really several tests under one "umbrella" . It sounds like, unfortunately, they didn't do anything they didn't tell you they were going to do...they just didn't explain it.

But I don't understand why your insurance won't cover it. It is a fairly routine test.

 

[CarolA]

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.

OK Enought with the letters

1. Show up at the Doctor's office. Take the bills etc. Stand in the LOBBY and LOUDLY tell the receptionist that you want to talk to the Doctor KNOW about the FRAUDULENT billing you received there. Mention that you are going to contact CMS> (Who cares if you aren't Medicare, it freaks them out LOL!) By the way the performance and billing for tests that are NOT medically necessary is generally considered fraudulent billing.

2. Ask for your Medical Record and then ask them to JUSTIFY the tests performed. Once again do this in the lobby. They don't want this going on in front of thier current pateints. Trust me! Explain the meaning of Fraudulent billing (Tests not performed for VALID medical reasons!) Make them show you THIER orders to the LAB to make sure it's not just the lab.

2. Call your local TV (Fox is always good for this kind of junke) See if they would like a story on Fraudulent billing. Even if all they do is call and ask the Doctor's office it will make thier skin crawl

The tests the OP lists are not all part of a standard CBC. Thyroid etc is not CBC in most labs and if it is here... once again we have an issue.

 

[vhoffman]

Not to get off topic here and hijack your thread, but here's what happened to a friend of mine several years ago.

She had surgery on her hand. She double checked to make sure the hand surgeon was a preferred provider on her insurance list. Then she had an initial appointment, and, sure enough, it was billed through her insurance as a preferred provider, no balance billing. Seemed straight on.

The she went in for hand surgery. Immediately after surgery she went for several sessions of hand therapy. Then she gets a bill fo $60,000 not paid for by insurance~ How could that be? Surely must be some sort of mistake. The EOB said non-payment due to using an out-of-network provider. She called back her insurance co, to inform them that a mistake had been made, her doctor was definitely a preferred provider.

Oh, BTW, she made complaints to the AMA (which is a private organization, not a regulatory organization), state board of medicine, attorney general's office, the answer was the same--the doctor had acted in a legal manner and she had no recourse.

Yes, indeed, her doctor was a preferred provider. But his hand therapy clinic was not a preferred provider. He not only billed the therapy under the hand therapy clinic's provider number, he billed the surgery using the hand therapy's provider number! Surely that's fraud? No, sorry. I even called on her behalf--she's somewhat hard of hearing and English isn't her primary language. I was told that its actually legal for a provider to bill under any provider number he legally holds, its the patient's responsibility to verify if the provider is in network or not. But what can you do when the SOB has multiple provider numbers and choses the one best suited to him, without your knowledge?

They ended up working out a payment arrangement with said doctor, still owed $15,000, SOB acted like he was doing them a favor by writing the bill down then setting up a payment plan.

Since then, I make sure to get my doctor's provider number and write on all statements of financial responsibility that I will only be responsible for charges filed under that number. I've never had such problems with my doctors, but you never know. What a $hitty thing to pull on someone--even if they were just a lowely patient. The patient, of course, is the lowest form of life in the medical world!

 

[wdwfamilyinIL]

We have a hospital like that here, the hospital is in our network, but all of their doctors are not.

My biggest thing is just the fact this went on behind my back. Even if nothing changes I have been a pain in the butt to the office, so hopefully they would think twice before ever doing this again. When a doctor's office invits you to ask questions, and then makes sure to avoid answering, it is pretty clear that they know what they are doing is wrong. If they come back now and yest we did improperly dictate her records what is going to happen to them?

 

[Debbie7452]

Dear OP- I can help you figure out what the Dr. was looking for which might answer some of your questions. Those tests are checking for evidence of an Autoimmune Disorder, such as Lupus.

I have been there, done that. I went to the Dermatologist for an annoying itchy rash and they started talking about Lupus (I was 12 weeks pregnant, too). I was shocked...I mean it's just a rash for heaven's sake. However, when I got the ANA test it was abnormal and I had to go get the full screen done at the Rheumatologist. Mine cost like $2000, but...everything was explained to me very carefully by both Dr's. I totally agree that you were blindsided. That is not right.

Oh yeah, some of my other results were also abnormal, so they were on the right track. But, I am OK and the baby turns 1 year old this month

Debbie

 

[wdwfamilyinIL]

I am glad to hear that you are ok. I know what all the test's are, my biggest thing was the fact that I didn't have the s/s to warrant such bloodwork. With lupus a common finding is something called the butterfly rash on your face. Like you also noted I was blindsided, if any doctor is going to order so many tests, then they need to learn how to be upfront and honest. Not to mention I knew I had thyroid problems, I was dealing with those issues with my primary. I am just a real big person on honesty, I don't like to be mislead or lied to, and if you do make a mistake, say so don't try to cover it up.

 

[Debbie7452]

You are so right, I agree.

BTW, I didn't have the butterfly rash or any other symptoms of Lupus (and still don't, so far!). My rash was on my arms. However, I do have a thyroid problems.
I was told that the thyroid issues were also caused by an underlying autoimmune problem. So taking all of that evidence together is why they ordered the tests for me. I'm not saying it was right for you, but it will help you get inside your Dr's head. Although, why he wouldn't just tell you that is beyond me. I am NOT trying to tell you that anything is wrong with you, really!

Good luck with your current issue. I know those kinds of things just eat me up!

 

[emerymt]

I would say that it is a serious problem of miscommunication, and that the nurse may not have understood what is included in a CBC, which does indeed only need one vial. Not all nurses have equal training, it's often very hard to tell their level of education. She might even have only been a phlebotomist, who knows. She probably meant a complete blood workup, the definition of which varies from office to office. A complete blood work-up for an unidentified rash in a dermatologist office probably would include everything you mentioned.

You have a primary care provider whom you did not see for this rash. Therefore, you and he/she must have thought it might be a fairly serious problem, one worth going to the dermatologist for. The tests that dermatologist ordered are appropriate for ruling out the really serious problems that could have caused this. What if he/she hadn't tested for them and you did have lupus or another serious disorder? It's great to know in retrospect that they were all negative, but if they had not been, the consequences would be much different and you would not be concerned about a copayment on an $800 bill.

Having said that, I always find out exactly what tests are needed, and bring any I already have with me. Especially xrays. We'll be making the rounds of the dentist/orthodontist/oral surgeon this month and they don't need to redo all the original xrays, but they will if I don't bring the first set. It's not out of greed. It's because they're busy and don't have time to track down my xrays, or labs, and probably couldn't get them without a signed, faxed consent form.

That's the main advantage of going to a large multi-specialty clinic. If all the doctors are partners or employees of the same corporation, they can easily access your records. If they're not, it's much more difficult to do.