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Old 08-06-2012, 12:22 PM
 
43 posts, read 158,117 times
Reputation: 38

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I've withheld the doctors name since I was not sure of the forum rules but would really need some guidance on how to resolve this.. Also apologies for the lengthy notes below.. Following is my wife's concern and I'm trying to help her resolve this with the doctor..



==========================

I went for my annual physical exam with a ob-gyn in round-rock and as part of the check-up I had specifically requested her to conduct only the blood work which needed to be done which are preventative per the insurance so that they are covered 100% and I do not end up paying any deductible. However, she went ahead and authorized blood work done which was of type "Diagnostic" per the insurance and hence I now have a $111.73 bill. I talked to the Lab which conducted the blood work and the insurance company and they referred me back to the doctor's office to resolve it.

I've reached out and left multiple voice-mails to the clinic's billing office and the nurse and they called me back only after a week. The nurse talked to me and mentioned that their is nothing they can do to resolve the issue as the tests were conducted because I have verbally committed to the tests during my checkup. I clearly told them that the only thing which I've accepted to was the tests which are covered by insurance and fall under the "preventative" or "annual check-up" procedures.

My husband later talked to the nurse to resolve and make progress on the situation and the nurse came back with the same logic that I've accepted the procedure verbally. My husband was totally upset with the unprofessional explanation and mentioned that he will follow-thru by registering an online complaint and also post in on online boards how we ended up with a $111 bill just for getting a annual check-up done at their office even though our insurance covers 100% of all the exams/blood work done as part of it. He clearly explained to them that it is unethical of them to go get blood work done without clearly explaining what is preventative vs diagnostic type of tests. Upon this explanation, the nurse broke down on the phone and apologized and said that she doesn't have the authority to nullify the charges with the lab which conducted the tests. Only the doctor or somebody higher-up can do the follow-up. Point to be noted, when my husband mentioned that he is going to file a complaint and post it on online forums/boards, the nurse breaking down made us more determined that the office has some nefarious practices and making them understand that we are not going to accept it silently exposed their vulnerabilities.



The next day the doctor called me in the morning(around 8:30am), and asked for my husband. Because my husband was attending a meeting, I mentioned to her that if she can call at a different time she can talk to him. She said that she is extremely busy and is a very important person and needs to talk to my husband now or never. I clearly mentioned that we understand that she is busy and she should be accommodating for a different time considering that its an urgent meeting at work which my husband has already dialed into. Anyways, the doctor would have none of that and said her charges are fair and she will not authorize any cancellation of charges. Through-out the call, she was very rude and claimed that she is the busiest doctor and its her normal practice to go ahead and ask for these tests done for any patient who comes to her office. She also claimed that she works with 700 insurances and its not her job to consider what is preventative vs diagnostic type of tests. She hung up the phone denying my request to give an alternate time for my husband to talk to her. My husband and I reached out and left voice mails later with their office couple more times and haven't heard back from them.


Couple of day's later, the lab which conducted the medical tests sent us the bill again mentioning that we owe them the entire amount. Today we got a letter back from the doctor's office that they cannot offer their services and we would need to pay an additional $25 for our records to be transferred out of their office. We anyways do not worry about seeking her services anymore but the $ amounts resolution and exposing the unethical practice of the ob-gyn is what are interested in..


So far, our repeated efforts to reach out to them are unsuccessful and we are wondering what are our options to pursue to resolve the issue.

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Old 08-06-2012, 01:16 PM
 
Location: Volcano
12,971 posts, read 25,861,527 times
Reputation: 10679
First option, I believe, is to bring a little more understanding to the situation. Mistakes happen. When you approach people with kindness and patience about correcting mistakes I find they will be cooperative more often than when you approach them with accusations and anger. From the tone of your post, I get the impression you were less than understanding in trying to get this resolved. I could be wrong, but that's how it seems. And you did escalate to threats.

As one small example, you don't seem to understand that the doctor called early in the morning because that's generally one of the two times of the day doctors have the time to make calls. The other is late in the day. I don't believe the story that the doctor was only willing to talk on that specific day or not at all. That defies common sense and seems like embroidery of your story to me. And doctors don't "fire" their clients without a very good reason. I suspect that your interactions with her staff were considerably less than kind or understanding, and that is the reason they are declining to provide you with further service.

Try retelling your story using only the facts, and leaving out the drama, which is all about your interpretation. I think that will paint a very different picture, and might suggest a possible resolution.
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Old 08-06-2012, 01:58 PM
 
Location: Austin, TX
14,379 posts, read 31,560,368 times
Reputation: 7724
Well empathizing somewhat with you, it is NOT the doctors responsibility to know what your insurance does or does not cover, the are correct in pointing out the numerous possible variations in what is covered. If you are that particular about what tests are run or not run, you need to ask the drs. office (ahead of time) to supply you with the list of tests that are requested of the lab, then forward that to your insurance company. A doctor is responsible for giving good care, and insurance company is responsible for taking your money.....
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Old 08-06-2012, 03:31 PM
 
43 posts, read 158,117 times
Reputation: 38
Thanks for the responses. Let me give more facts of whatever happened so far..

First thing, we did when we saw the bill from the lab was to call the lab and ask them what are the tests rejected by the insurance, then followed thru with the insurance company and found out that the reason the charges were incurred because the tests done were of type "Diagnostic" meaning per their guidelines they do not recommend these tests. Follow-ups with the lab and insurance took us couple of calls but later the process was dragged by the doctor's office for almost a week with absolutely no responses from them(meaning we left the message with the person who answered the phone or left voice mails with the billing department and the nurse) almost every day of the week until we finally heard from them after almost a week. The lack of a professional follow-thru from the doctor's office left us totally frustrated.

The call to my wife after a week was very abrupt by the nurse and she mentioned that this is a test they do for every patient of theirs and my wife had an option to walk away from that, follow-thru with the insurance company, come back to their office and get the test done. My wife was also suggested that they will be careful in explaining all the tests/exams done in a very detailed manner going forward to which my wife's response was that we will not engage their services anymore. I thought its better for me to get into a conversation and called the nurse again and had to wait for couple more days for a return call. When she did call, she mentioned the same and they will not reverse the charges, thats when I asked her clearly on how this can be professional and I'll file a complaint thru BBB, to which to my utter surprise she broke down and said that she doesn't know why the doctor has recommended the tests and any authority to cancel the fees is beyond her.

Next day, the call from the doctor with my wife happened and hence forth we are not able to reach her office regarding this issue(our voice mails are not returned).
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Old 08-06-2012, 03:38 PM
 
3,517 posts, read 6,254,302 times
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If paying for a few lab tests was such a huge deal to you, why didn't you talk to your insurance ahead of time about what is covered for an annual? Insurance plans vary from company to company and from policy to policy. Doctors may have a vague idea about what tests and procedures are usually covered or usually not, but not for minor routine bloodwork.

The people screwing you over is your insurance company, not your doctor and you might have been able to get your doctor's office to submit a different ICD code so your insurance considers those tests "preventative", but now you've burned that bridge completely. Your best option now is just to pay your bills, write a complaint on a site like Angie's List, and be more prudent about your healthcare needs.
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Old 08-06-2012, 03:39 PM
 
Location: NYC
16,015 posts, read 24,428,037 times
Reputation: 24635
The OP did know what was covered and specifically asked not to have other tests run.

Sorry, missed the post with lots of details.

I think you are unfortunately screwed. The office ran tests that they consider preventative, it is your word against theirs. The best that you can do is write them a letter certified mail, copy the insurance company saying you should not be responsible for the charges. Due to their failure to return your phone calls you are writing them a letter.

My guess is your wife signed something stating she would be responsible for all charges before the appointment. This covers the doctor.

Last edited by veuvegirl; 08-06-2012 at 03:44 PM.. Reason: missed post
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Old 08-06-2012, 03:55 PM
 
Location: Mostly in my head
19,859 posts, read 61,433,657 times
Reputation: 19275
No doctors office can know that all of the charges, test procedures et cetera are covered or are not covered by any particular insurance company. All of my doctors offices have big signs that say verify with your insurance. I sympathize with your wife but she shoulda been a little more proactive ahead of time in talking to your insurance company also it sounds like she is a new patient to this practice and maybe that has something to do with it. Also in any event for the future what she needs to do is have her new doctor give her a release form that she will sign and then they will communicate with the old doctors office about getting her records. Yes they will charge you 25 dollars if you want to go in there yourself and get your records what they normally send free of charge to another doctor's office.
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Last edited by SouthernBelleInUtah; 08-06-2012 at 05:04 PM..
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Old 08-06-2012, 03:59 PM
 
11,451 posts, read 48,448,740 times
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With the progress of events to this point, the prospect of a mis-communication about what tests would be covered and which ones wouldn't between your doctor and you and your husband are all moot points.

The doctor apparently provided her services which in her professional judgement were needed, ordered tests which she considers routine for the exam, and the lab did what was ordered and supplied the work product results. Both of them are now entitled to be paid for their services.

Even though you notified the doctor that "diagnostic" tests wouldn't be covered by your insurance company, unless you handed the doc's office a specific listing of the tests that would be approved or disapproved, they had no way of knowing which was which according to your insurance company.

The only option you have left to resolve the charges are in the hands of the practice manager, if that person will hear your complaint and act upon it. It sounds like the doctor has already determined that you aren't somebody that they want to provide service for in the future, and that appears to be the decision that you've made, too. So I wouldn't expect much change from a practice manager, but you won't know unless you contact them.

Otherwise, you're still liable for the lab bill and they are entitled to pursue you for it. Is it worth having your credit affected over a $111 billing?
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Old 08-07-2012, 11:16 AM
 
15,610 posts, read 22,152,011 times
Reputation: 22675
I agree with all who've said that it's the patient's responsibility to know what is and what isnt covered by the insurance.

I also wonder why, when the doctor called and the husband wasnt available, the wife didnt discuss this issue with her. After all, the wife was the patient and should have had the best knowledge of the issue.
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Old 08-07-2012, 03:01 PM
 
Location: South Carolina
14,790 posts, read 21,572,345 times
Reputation: 26914
Just pay the drs bill or lab bill or what have you and then cancel your insurance and go with another insurance company this insurance company sounds like they dont want to pay for anything but they want to take your money . Just call them up and explain since all this has happened you think you would be happier with another health insurance company and watch the scrambling begin and the back stepping too . I wish you luck I know how hard this is ... Im disabled and im dealing with government insurance Boy howdy what a ride that is . consider yourselves lucky that you have insurance when 50% of americans cannot afford health insurance and we are not really happy with what obama is going to throw at us .
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