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Getting screwed by doctor office

Discussion in 'Off-Topic Discussion' started by nd, May 28, 2009.

  1. May 28, 2009 at 1:03 PM
    #1
    nd

    nd [OP] Radical Town. It's a hell of a place!

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    Ok, i'll warn you now that this is going to be long since it involves insurance talk, doctor office talk, and lawyer talk. But here's the short version...

    I want to go to an ear nose and throat doctor cause i get sinus infections alot.

    My doctor says first i need to see an allergy doc then he'll refer me to an ent guy.

    i got to allergy doctor. I know i'm allergic to pollen (who isn't?). but they are gonna do a full allergy test. so when they call to confirm my appointment i ask them "whats this whole thing gonna cost me?". They say "just the office visit copay, everything else is covered by insurance" i say "great"

    so i go to the allergy doc and they jab me 40 something times with different allergen tipped needle things. they tell me i'm allergic to pollen and then i proceed to itch the rest of the day.

    about a month ago i get a doctors bill for $309 dollars (i already paid the $40 copay the day of the visit).

    I call them up and say "whats this?" they say to call my insurance company. i do

    insurance tells me that the doctors office called to confirm my benefits. when they called they did not ask about the allergy test, they asked about injections. Injections are covered 100% but the test is not. So the office originally called to ask about injections, but when they billed they billed for the test. this is where things get complicated....

    so i call the doctor and say, you guys made a mistake, i'm not paying. the lady said she'd have one of the office managers call me back. i never heard from them. so i called to speak to an office manager today. i explained what happened and afterward the conversation went like this

    Me: i knew i was allergic to pollen, the allergy test was a formality so i could see an ear nose and throat guy. I asked if it was gonna cost me anything and your office said "no". if i had known it would cost me $300 i never would have gotten the test done.

    Her: regardless, you owe us $300

    Me: why would i pay to get tested just to confirm what i already know?

    Her: but you got the test, so now you owe us money

    Me: i only got the test because i thought it was covered. why dont you understand? if you had told me i had to pay, i would have turned it down.

    Her: But you got the test

    Me: yes, based on misinformation i got from your office. its your mistake, i'm not paying for it.

    Her: but you got tested, so you have to pay for it

    Me: i'm not paying

    Her: we will have no choice but to turn this over to a collection agency

    Me: ok, i'll be seeking legal advice

    So, i call my insurance company. they keep records of when an office calls in for benefits. Here's what i found out...

    technically, since i have a PPO instead of HMO, it is MY responsibility to find out what is covered. i did not know that until today. However, in my opinion the office is still at fault, here is why.

    I asked them what it would cost me. they said "just the copay, everything (key word, "everything") else is covered completely. When they said "everything" that should include everything they know they are going to do to me. If they had said "i dont know" or "you'll need to contact your insurance company to find out" or "we dont know but we'll contact your insurance company and let you know" or anything else, i wouldn't have a leg to stand on. but instead they said "everything".

    So after talking to the insurance lady she said they called and asked what my benefits were for the office visit and ALLERGY TREATMENT. they never even asked about ALLERGY TESTS. big difference. TREATMENT is the injections you get after you find out you have allergies. TESTS are the little things they stick you with to see if you react. why would they call to ask about treatment of something i haven't been tested for yet?

    If you took your truck up for a warranty issue and they told you it would be free. then you pick it up and they charge you $300 because they just noticed you were over your warranty mileage AFTER they did the repair, would you pay it? i wouldn't. you cant give someone a price, render services, then charge them more afterwards.

    So, i have a legal plan as part of my benefits package. i have contacted a lawyer and am waiting to hear back. it should be free to have a lawyer get involved. i'm hoping once the office gets a letter from my lawyer they'll decide $300 isn't worth the trouble and drop the bill.

    So for those of you still reading, what do you think? lawyer the right way to go (especially since its no cost to me)? i welcome all input from lawyers or insurance people/experts. Thanks for reading this small novel. Rant over
     
  2. May 28, 2009 at 1:14 PM
    #2
    mws4ua

    mws4ua I'll try being nicer if you try being smarter.

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    Damn. I don't know all of the rules, but it's certainly worth involving a lawyer that you have through group legal coverage. You are doing exactly what I would do if put in the same situation.

    The problem you could run into is that you can't *prove* that the lady said it would be a co-pay and everything else would be covered. I suspect the lawyer will say that without proof, the law and rules are on their side. If the lawyer tells you that, pay the $309. You will legally owe it (though I think anybody who reads your post will agree you shouldn't), and even $309 isn't worth what a collections agency will do to your credit.
     
  3. May 28, 2009 at 1:19 PM
    #3
    lsocoee

    lsocoee My hair is all natural Moderator

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    First off, can I change the thread title to "Getting screwed by mjp2"

    Second, I've been screwed over for hundreds of dollars by doctors/insurance issues. I'll tell you the worst are the diagnostic centers. They say everything is covered and then they end up sending you a bill.

    I have made it a policy to check with the doctor's office and my insurance every time before I go in. My wife had blood work done at the location that her doctor told her to go and we got charged for it. It is ridiculous.

    When I call them up, they always try to hide behind some technical mumbo jumbo language, and I play dumb and make them spell it out for me. To make matters worse, Ochsner (the biggest medical firm in new orleans) is HORRIBLE at sending out bills. They routinely send out bills that the insurance will cover and it is then up to the patient to call them up and spend 45 minutes on hold to clarify this with Ochsner, then you have to call up the insurance company, etc...
     
  4. May 28, 2009 at 1:21 PM
    #4
    lsocoee

    lsocoee My hair is all natural Moderator

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    pay the $309, but go poopsie daisy the office manager's car.

    you're not going to win the battle and they may just end up fucking up your credit.
     
  5. May 28, 2009 at 1:22 PM
    #5
    David Tarantino

    David Tarantino Well-Known Member

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    my wife works in a docs office she sees this all the time
    i just read this to her and after she said she was going
    to kick me in the nuts for calling her at work:eek:
    she said to get the lawyer as soon as the docs office
    heres from him she sure it will be droped
     
  6. May 28, 2009 at 1:27 PM
    #6
    lsocoee

    lsocoee My hair is all natural Moderator

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    I'm with David, but I wouldn't bring them to court.
     
  7. May 28, 2009 at 1:30 PM
    #7
    Toy4Life

    Toy4Life 668: The Neighbor of the Beast

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    How are you getting a lawyer to do something for free?
     
  8. May 28, 2009 at 1:31 PM
    #8
    David Tarantino

    David Tarantino Well-Known Member

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    I dont think it will go to court the cost may be more then
    its worth but iam not a lawyer
    iam sure someone on here knows more about this then me
     
  9. May 28, 2009 at 1:32 PM
    #9
    mws4ua

    mws4ua I'll try being nicer if you try being smarter.

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    It's not free. It's covered by his benefits package. We have something similar where I work. I don't subscribe to it, but it's like $7/check for legal coverage.
     
  10. May 28, 2009 at 1:32 PM
    #10
    lsocoee

    lsocoee My hair is all natural Moderator

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    my benefits also include a lawyer, but all they do for you is talk to you about your legal rights for an hour and then they offer discounted rates.

    You don't have any lawyer friends that could write something up on their letterhead?
     
  11. May 28, 2009 at 2:16 PM
    #11
    nd

    nd [OP] Radical Town. It's a hell of a place!

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    thanks for reading everything through. i dont want to let it get to a collection agency, so i'll pay it before that happens, but i'm gonna try to fight it until then. i know i dont have any proof but hopefully my argument of "i knew i was allergic to pollen, why would i knowingly pay to find that out" will hold up

    yeah, i've noticed it happen quite a bit but this is the most expensive so far and the only time i asked in advance what it woudl cost me (since the test was completelly pointless and i already knew what it would say)

    thanks for asking your wife. yeah, i dont want to take them to court but i'm hoping the lawyer can send them a letter and they'll decide $300 is not worth the bother

    i wont, i dont have time for that plus the lawyer is free but i'm sure court wouldn't be.

    part of my benefits at work. free legal service. i have to pay for paper work. for example, i'm getting my record expunged of a PDC charge from about 5 years back. i have to pay the filing costs and all that but the time the lawyer actually spends with me and and the time he spends getting things cleared up is covered by my benefits.

    yeah, i think its $11 a month

    mine doesn't have a limit. lawyers outside the approved list get a discounted rate, but the ones i can choose from are 100% free. hopefully he can have a letter drafted up for free.
     
  12. May 28, 2009 at 2:25 PM
    #12
    borderbrat

    borderbrat Watching Chris4x4 o.O

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    glad i don't have to deal with this sort of crap:canada:
    sorry i have nothing usefull to add
     
  13. May 28, 2009 at 2:29 PM
    #13
    nd

    nd [OP] Radical Town. It's a hell of a place!

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    yeah, you just have to deal with mapple syrup floods and french canadians..... personally i'd rather deal with the insurance companies

    thanks, i hope so too. the legal package is a nice little perk. for little stuff its free and for big stuff (getting sued etc....) you come out way better than you would if you just went and found a lawyer on your own.
     
  14. May 28, 2009 at 2:31 PM
    #14
    lsocoee

    lsocoee My hair is all natural Moderator

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    my vote is still for the poopsie daisy.
     
  15. May 28, 2009 at 2:43 PM
    #15
    cntstan

    cntstan Well-Known Member

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    That $309 is probably the full charge of the test. If I were you, I would say.............I know this person so and so and they had this same test but their insurance covered it and their insurance only had to pay 30-40% of that (that's because insurance companies NEVER pay the full amount, they base what they pay on medicare percentages and blah, blah, blah). Ask if you can do the same because even though they screwed up, you still want to be a stand up guy and keep your credit intact. I know it sucks to have to pay when you were told something different but it might save you some good money. Just make up a plausible story and I think you might be surprised at what they are willing to accept. I AM NOT A LAWYER!!!!! This could also be some type of fraud and you could end up in prison but hey...life is short.:)
     
  16. May 28, 2009 at 5:11 PM
    #16
    ImpulseRed008

    ImpulseRed008 Gone But Not Forgotten

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    You're paying for the lawyers, might as well get your $$ worth out of what you pay.

    I agree with cntstan, see what insurance companies would pay and agree to pay that - maybe put that in the legal papers you give them.... That way they're getting something and it shouldn't matter who they get it from.

    Hope it works out for you.
     
  17. May 28, 2009 at 5:36 PM
    #17
    chris4x4

    chris4x4 With sufficient thrust, pigs fly just fine. Moderator

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    Im gonna agree with Hot Dog.......
     
  18. May 28, 2009 at 6:18 PM
    #18
    ImpulseRed008

    ImpulseRed008 Gone But Not Forgotten

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    +1
     
  19. May 28, 2009 at 10:59 PM
    #19
    nd

    nd [OP] Radical Town. It's a hell of a place!

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    full charge for the test was $679 dollars. so my insurance covered the majority of it but not all of it. roughly half. but accordint to the office they were gonna pay all
     
  20. May 29, 2009 at 8:05 AM
    #20
    cntstan

    cntstan Well-Known Member

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    Now that's one I've never heard of. I can see if you had some kind of 50-50 plan (ins. pays half and you pay half) but most of the time it's like a 80-20 or 90-10 plan. My wife routinely will bill insurance for repairing someones hernia or taking out their gallbladder but she never, and I mean never gets paid 100%. Most of the time it's 25-30% and the rest is considered a writeoff (money that never gets paid). I'm sure this test is not considered "experimental" so how they can justify paying less than half I just don't get. At most it seems you should be responsible for 10-20%. $679 seems like the price they would charge if they knew ins. was only going to reimburse 30-40% which still would mean you should only have to pay 10-20% of the total charge if you're on a "normal" 80-20 or 90-10 plan. Wish I had more answers for ya' but it certainly does seem screwy to me! Good luck!
     
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