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This isn't the first time I've seen this medical scenario played out in various ways, and I'm wondering if there is name in the medical industry for this, and/or a local entity to which I report it.
Situation: Spouse and I saw “Dr. X” a few times at the multi-doctor Seattle-area clinic we use. We generally saw him on weekends at the weekend/after-hours clinic. We didn't tend to make actual appointments with Dr. X, because he's condescending and abrupt, but we saw him at the after-hours clinic on a "better than seeing no doctor at all" basis.
Last September, we went to the after-hours clinic on a Saturday and there was a handwritten sign on the door to use the door about 30 feet to the left. We did so, and once again it was Dr. X seeing patients.
So, Spouse got treated and then last month got a bill from Dr. X, on which there was a note that insurance did not pay the bill. I don't know why it took them so long to send the bill.
It turns out that Dr. X broke off from the clinic and is now a separate entity. In the same building. NOBODY told us this. In fact, months later, Dr. X's website still lists his affiliation and phone number with the original clinic! He’s also still listed at the old clinic on various professional websites. Apparently he was still affiliated with the old clinic enough to easily get Spouse's medical records that day, so the division between the entities seems pretty hazy.
When we got the first bill a month ago, we called Dr. X's billing coordinator and she said she'd call the referral coordinator for our clinic in order to ask for a retroactive referral. We got another bill yesterday so we called to ask what happened to her calling the billing coordinator. She said she couldn't do that and we'd have to. Uh, okay. So we called the billing coordinator for our clinic today and were told they couldn't do the referral.
Our clinic says they can't do a retroactive referral to see Dr. X, because he is a primary doctor rather than a specialist. We called our insurance plan, and they won't pay because we (unknowingly) didn’t go to our assigned clinic. Dr. X is still an approved provider with our insurance plan, but we’re not assigned to his practice so they won’t pay.
We are not sure who put the handwritten note on the door of our clinic advising us to use the door to the left. Seems scammy.
I've seen this type of thing before with people checking into a hospital with their insurance or credit card and being told "everything" was covered, and not being told that X-rays and sonograms were going to be performed and billed by a private radiology clinic which resides in the same building. It would be like buying a car from a Ford dealership for $30K, then months later getting separate bills from Goodyear for the tires which Ford never mentioned weren't covered in the cost.
Anyway, is there some kind of Washington policy or law about this, a name for this practice other than "sleazy", and/or an overseeing Washington/Seattle entity that would be interested?
I'm just making a wild guess but it's possible that Dr.X or one of his staff put that note on the door...
If you want to spend time on this legally, I would start with the AG's office -- go straight to the top: What the Office Does
This page explains not only how to contact them but also what the office actually does and how it can help consumers: Contact Us(1)
I don't think the government is going to protect you on this. Go back and read the paperwork you signed when service was provided by Dr. X. Odds are good that you signed something that said you were responsible for the bill if your insurance didn't cover it.
The Washington State Attorney General's office does have a consumer protection division but I don't think they will be able to help you. I could be wrong so check out Safeguarding Consumers for more information.
Last September, we went to the after-hours clinic on a Saturday and there was a handwritten sign on the door to use the door about 30 feet to the left.
The handwritten note seems odd but it's not related to what happened. (See below)
Quote:
Originally Posted by Dweeby
So, Spouse got treated and then last month got a bill from Dr. X, on which there was a note that insurance did not pay the bill. I don't know why it took them so long to send the bill.
It turns out that Dr. X broke off from the clinic and is now a separate entity. In the same building. NOBODY told us this. In fact, months later, Dr. X's website still lists his affiliation and phone number with the original clinic! He’s also still listed at the old clinic on various professional websites. Apparently he was still affiliated with the old clinic enough to easily get Spouse's medical records that day, so the division between the entities seems pretty hazy.
When we got the first bill a month ago, we called Dr. X's billing coordinator and she said she'd call the referral coordinator for our clinic in order to ask for a retroactive referral. We got another bill yesterday so we called to ask what happened to her calling the billing coordinator. She said she couldn't do that and we'd have to. Uh, okay. So we called the billing coordinator for our clinic today and were told they couldn't do the referral.
Our clinic says they can't do a retroactive referral to see Dr. X, because he is a primary doctor rather than a specialist. We called our insurance plan, and they won't pay because we (unknowingly) didn’t go to our assigned clinic. Dr. X is still an approved provider with our insurance plan, but we’re not assigned to his practice so they won’t pay.
We are not sure who put the handwritten note on the door of our clinic advising us to use the door to the left. Seems scammy.
I've seen this type of thing before with people checking into a hospital with their insurance or credit card and being told "everything" was covered, and not being told that X-rays and sonograms were going to be performed and billed by a private radiology clinic which resides in the same building. It would be like buying a car from a Ford dealership for $30K, then months later getting separate bills from Goodyear for the tires which Ford never mentioned weren't covered in the cost.
Anyway, is there some kind of Washington policy or law about this, a name for this practice other than "sleazy", and/or an overseeing Washington/Seattle entity that would be interested?
You should file an appeal with your insurance company because you intended to go to your primary care physician (or clinic in this case) and believed you were going to your primary care clinic. From what you describe, an ordinary person wouldn't understand that Dr. X is now part of a different practice.
I think there are a couple things you can press in here.
- You had no way of knowing that Dr. X is a different clinic
- You did not receive notification in the mail that Dr. X has been split off from the clinic
- Your records were transferred to a different clinic without your authorization. This would be a HIPAA privacy violation.
If you're willing to pursue it, a potential HIPAA privacy violation would be a huge card you can play. Read what the original clinic's privacy policy is regarding sharing of data. I don't believe they will allow it to be shared with another clinic. If Dr. X indeed received your spouse's medical records, you have an excellent case.
In any case, file one or two (if allowed) appeals with your insurance company. Hopefully they will be good about it.
Your records were transferred to a different clinic without your authorization. This would be a HIPAA privacy violation.
That's interesting. I did not think of that. It is pretty disturbing that, despite the theory that they're separate clinics, transferred the medical file seamlessly that day. It seems to me that different clinics shouldn't have physical access to each other's files.
Call them and see if Dr. X can bill your insurance from the original clinic (the one your assigned to as a patient). They might be able to do that.
I had an insurance problem where the doctor my spouse went to wasn't in network. Instead, the billed her appointment under the name of the other doctor who was in network. Seemed weird to me, but it all worked out.
This isn't the first time I've seen this medical scenario played out in various ways, and I'm wondering if there is name in the medical industry for this, and/or a local entity to which I report it.
Situation: Spouse and I saw “Dr. X” a few times at the multi-doctor Seattle-area clinic we use. We generally saw him on weekends at the weekend/after-hours clinic. We didn't tend to make actual appointments with Dr. X, because he's condescending and abrupt, but we saw him at the after-hours clinic on a "better than seeing no doctor at all" basis.
Last September, we went to the after-hours clinic on a Saturday and there was a handwritten sign on the door to use the door about 30 feet to the left. We did so, and once again it was Dr. X seeing patients.
So, Spouse got treated and then last month got a bill from Dr. X, on which there was a note that insurance did not pay the bill. I don't know why it took them so long to send the bill.
It turns out that Dr. X broke off from the clinic and is now a separate entity. In the same building. NOBODY told us this. In fact, months later, Dr. X's website still lists his affiliation and phone number with the original clinic! He’s also still listed at the old clinic on various professional websites. Apparently he was still affiliated with the old clinic enough to easily get Spouse's medical records that day, so the division between the entities seems pretty hazy.
When we got the first bill a month ago, we called Dr. X's billing coordinator and she said she'd call the referral coordinator for our clinic in order to ask for a retroactive referral. We got another bill yesterday so we called to ask what happened to her calling the billing coordinator. She said she couldn't do that and we'd have to. Uh, okay. So we called the billing coordinator for our clinic today and were told they couldn't do the referral.
Our clinic says they can't do a retroactive referral to see Dr. X, because he is a primary doctor rather than a specialist. We called our insurance plan, and they won't pay because we (unknowingly) didn’t go to our assigned clinic. Dr. X is still an approved provider with our insurance plan, but we’re not assigned to his practice so they won’t pay.
We are not sure who put the handwritten note on the door of our clinic advising us to use the door to the left. Seems scammy.
I've seen this type of thing before with people checking into a hospital with their insurance or credit card and being told "everything" was covered, and not being told that X-rays and sonograms were going to be performed and billed by a private radiology clinic which resides in the same building. It would be like buying a car from a Ford dealership for $30K, then months later getting separate bills from Goodyear for the tires which Ford never mentioned weren't covered in the cost.
Anyway, is there some kind of Washington policy or law about this, a name for this practice other than "sleazy", and/or an overseeing Washington/Seattle entity that would be interested?
This is very unfortunate. There are times when practices share the same clinic to cut the overhead. Dr.X may be using the same clinic and staffing but a different practice. That being said, you went to see a different provider and were 'scammed' into seeing someone else. Now, someone raised the question of HIPAA. That actually is a great way to negotiate with any practice. I am not telling you to get ugly, but medical practices are very scared of HIPAA violations. All hospitals and practices are governed by rules and to go against them is asking for big trouble. I am sure if you were to talk to Dr.X directly about this, a mutual agreement can be reached. Practice managers are sometimes overbearing since their job is to bill as much as possible. I never recommed taking matters to the court since NO HARM WAS DONE. You will end up spending more money dealing with attorneys. Hope this helps.
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