Author Topic: Is it ethical?  (Read 1628 times)

disappointed

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Is it ethical?
« on: January 30, 2013, 11:25:49 PM »
I called my sons pediatrician to get a vacine that is required to start junior high.
They made anappointed which we went in.  The nurse came in and did the normal things, they took his vitals and started a vision and hearing test. Dr came in and asked him some basic questions.  She then told me that the nurse will be in to give his Tdap shot and that he is due for some other shots if it ok to give it to him.  Later I received a bill of 500.00 remainder of the difference that the insurance did not pay.  I refused to make the payment.  I called the dr office and ask if they can review the bill because I dont agree to pay that amount for the service that I did not request.  I asked if they bill the insurance correctly and she got offended since she is the one that bills and she does not make any mistakes.  She told me she will talk to office manager and she will call me back.
I left her a number where she can reach me.  I never heard from her.  Couple of weeks later I needed to take my son in for severe flu with a rash that look like the measles.  They refuse to make an appointment since I have a balance.  They transfer me to the office manager an she said she called me and left a message.  I told her I never got a call from her  She called a disconnected number and I told her that I left a good contact #. Her response was that she got my # from the file and not the message I left.  She proceed to say that I owe all the amount since I received the service.  I told her that I dont agree since I only went in for a Tdap vacine.  She said I should have decline the service.  I was not told if I wanted all the services done they just went ahead a did it.  I told her that I disagree with it.  she kept asking me that if i understand that I have a 2000 ded.  I told her that I knew my ded so she started arguing that I need to pay it.  Well I feel that I dont have to pay my ded if it is not necessary.  Since my son was very ill I had to pay the 500.00 bill so he can be seen.  Is there anything I can do?

RichardP

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Re: Is it ethical?
« Reply #1 on: January 31, 2013, 12:10:33 AM »
Regarding charges for services that you have authorized:  Does your doctor belong to your insurance plan?  Is he a participating provider?  If he is not, he can charge you any amount he wants and you have to pay it.  You mention deductible, so I'm guessing you saw a participating provider doctor - so both he and you are bound by the terms of the contract.

Regarding charges for services that you did not authorize, I have a few comments and a question:

1.)  It is the patient's responsibility to keep the doctor informed of changes in address and phone number.  The preferred way to do this is through written corresondence.  A follow-up call to the doctor to verify that the the changes show up in his computer is appropriate, perhaps a month or so after you submit the paper notification.  Otherwise, problems such as you have described will inevitably occur.

2.)  If you truely did not authorize the additional services, file a formal complaint with your insurance carrier.  At that point, the matter should be between your insurance carrier and the doctor.  But can your doctor prove that you authorized the services?  Did you sign anything whereby you agreed to be responsible for the charges?  If you signed such an agreement, and there were no charges listed when you signed, or charges were added after you signed it - that information should also be turned over to your insurance carrier.  They are not going to know about bad doctors unless they are told.

3.)  You could send a letter to your doctor telling him that you will complain to an online doctor rating service unless he drops the unauthorized charges.  But, again, can he prove that you actually did authorize the charges?

4.)  If this doctor is charging you for services you truely did not authorize, why do you want to take your children back to see him?

PMRNC

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Re: Is it ethical?
« Reply #2 on: February 01, 2013, 12:09:11 PM »
 I agree with Richard, however I have to add that the provider was indeed WRONG to not see your child due to balance. Physicians have rules/regs in place for dismissing a patient and clearly that wasn't done. They would have had to provide you with a formal letter, reason and referral to another office w/out bias in regards to balance.   I agree with Richard said about the $500 balance (I do pediatric billing, that really is very high, I'd want to see that bill myself)

Linda Walker
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www.billerswebsite.com

RichardP

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Re: Is it ethical?
« Reply #3 on: February 01, 2013, 12:40:33 PM »
Linda - our clients have patients who have seen the doctor maybe 4 or 5 times over the course of a year and have paid only the co-pay and nothing else.  It doesn't happen often, but it does happen that the doctor says he will not see the patient again until they have either paid something against their balance, or paid it in full.

Note that this is not the same as dismissing the patient.  The doctor is not dismissing the patient (a procedure that has rules to be followed, as you noted).  The doctor is simply saying he will see the patient again only after they have paid something/everything toward what they owe him.  It is OK for the doctors to remind patients, when necessary, that they don't work for free.

PMRNC

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Re: Is it ethical?
« Reply #4 on: February 01, 2013, 02:45:23 PM »
Quote
Linda - our clients have patients who have seen the doctor maybe 4 or 5 times over the course of a year and have paid only the co-pay and nothing else.  It doesn't happen often, but it does happen that the doctor says he will not see the patient again until they have either paid something against their balance, or paid it in full.

Note that this is not the same as dismissing the patient.  The doctor is not dismissing the patient (a procedure that has rules to be followed, as you noted).  The doctor is simply saying he will see the patient again only after they have paid something/everything toward what they owe him.  It is OK for the doctors to remind patients, when necessary, that they don't work for free.

A provider can not just refuse care due to a patient balance, NOT without proper procedure's followed.   I know this from experience. I've dealed with MANY insurance carriers however MY husband's OWN union insurance takes the cake.. My blood literally boils when I speak to them or open up an EOB.  They denied coverage for my daughter because she was over 19 and claimed they were grandfathered with the ACA.. indeed they were but NOT from the dependent care provision.. long story short she had charges from a doctor they denied while I had it in review and appeals all way up to the labor board (ERISA plans are not held responsible under state dept but rather state labor relations) .. She had to see this doctor on an emergency basis and they refused to make the appt until I got on the phone with the state medical society.. Someone called someone because they called my daughter back and got her in that same day.  The lady at the NY state medical society was actually appalled and said No way could he do that. Now I didn't get legal inferences on this because I didn't have to, she called them, my daughter got in and that's all I cared about.    Can you imagine going to the ER and they pull ya up and see you owe all those ER copay's and refuse to see you?     
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com