Doctor's bill - WWYD?

SO_Dad said:

If you 'settled up' at the doctor's office when you picked them up, it would seem that you've got a legitimate complaint against their office.  I wouldn't bother with the insurance part of this as it seems you're not covered.   



I'd go with

  " When I picked this up, I asked if there was a charge and your representative said 'no'"  I'm not paying for it.  You can have them back if you want them.  "



see where that leads you. 

+1

The instructions to appeal are likely right on the insurance statement you should have gotten denying the claim.

Point out their information is contradictory as it says there is a contract rate of $250, yet you are being charged full price.

Also, I have heard that insurance will sometimes covering drugs that aren't usually covered if a doctor makes a case for medical necessity....i don't know if it would work with orthotics...and if it does, i would guess it depends on the need....if there is an actually deformity like severe OA or just commone 'flat feet'

A somewhat different perspective.  I never rely upon the doctor's office to verify any potentialky questionable insurance related questions.  

So many years ago,  I called my insurer and avoiding getting inserts because they weren't covered.  BTW I told the podiatrist not to order them, and when they did, I refused to take them.  They were stuck with them and I didn't pay.

But  this is just a good policy.  I needed an MRI and it couldn't be scheduled until after New Year when I'd have a new deductible.   My dr office assured me that my insurer would cover it as if it were under the prior years terms, which would have minimized my payment.   

It sounded too good to be true, but when I called the insurer, I got the same information.   So when the insurer billed me for my deductible,  I protested the claim  - this was about $2K - telling them the name of their representative, the time of the call, etc.

Two weeks later, they honored my deductible because they reviewed the recording and heard I'd been given incorrect information.  That you are on a recorded line turns out to be true and useful.  

A somewhat different perspective.  I never rely upon the doctor's office to verify any potentialky questionable insurance related questions.  

So many years ago,  I called my insurer and avoiding getting inserts because they weren't covered.  BTW I told the podiatrist not to order them, and when they did, I refused to take them.  They were stuck with them and I didn't pay.

But  this is just a good policy.  I needed an MRI in December  and it couldn't be scheduled until after New Year when I'd have a new deductible.   My dr office assured me that my insurer would cover it as if it were under the prior years terms, which would have minimized my payment.   

It sounded too good to be true, but when I called the insurer, I got the same information.   So when the insurer billed me for my deductible,  I protested the claim  - this was about $2K - telling them the name of their representative, the time of the call, etc.

Two weeks later, they honored my deductible because they reviewed the recording and heard I'd been given incorrect information.  That you are on a recorded line turns out to be true and useful.  

And if someone tells me that something is covered and I am not, I call and verify.  

dianaid, that's smart and I definitely should have done that. I had no idea the orthotics were even this expensive!!

TarheelsInNj said:

I'm not sure if I really have a leg to stand on... 

I,d consider writing the dr a letter stating the prob, emphasizing that THEY failed to proceed properly, and that you would NOT have ordered the stuff iIF you had been notified.  In huge caps cc the appropriate medical ethics panel.

Please post follow ups.

"Even if the complaint doesn't go anywhere, the podiatrist will think twice next time (hopefully)."

Especially if your (first or second) complaint is cc'd to the relevant state regulator.  Who knows, maybe they have already received complaints like yours against this doc/office and could build a case for at least reprimand.

CC these guys:

http://www.njconsumeraffairs.gov/bme

Thanks all! I'm really not sure that I should make any kind of formal complaint here. Ultimately it is my responsibility to verify the coverage and I think that would be their response. I just think this was a pretty *****ty way to handle it. So I definitely want to express my anger/disappointment and see if they'll work with me but "legally" speaking I don't think I can claim any wrongdoing on their part.

I'm in this same boat. I just spent too long yelling at the provider who didn't tell me that they are out of network before they performed the procedure. I'm livid. I don't know what I'm going to do.

Tom_Reingold said:

I'm in this same boat. I just spent too long yelling at the provider who didn't tell me that they are out of network before they performed the procedure. I'm livid. I don't know what I'm going to do.

oh, no... I'm sorry to hear that. That sounds like a much more expensive problem than mine will turn out to be, and a big hassle to boot!!

The out of network thing happened to me a couple of years ago when I had a sonogram done on my throat and the doctor I was working with wanted a specialist to read the resulting report. No one asked me to give the okay when they chose a doctor to review the results, and I ended up with a $500 bill my insurance wouldn't cover. 

Regarding the podiatrist issue, have you tried talking to the doctor himself, rather than the officer manager/billing person? I had a problem with a similar issue with my ENT specialist years ago, and the office manager kept billing me for something I knew was b.s., but they would not relent. I raised the issue with the doctor herself during an exam, and she said, "Don't pay it. I'll take care of that." Never heard from the office again.

I heard back from the office in response to my letter, and they said they did verify the benefits and were told that the orthotics were covered. They're going to appeal and if that doesn't work, they'll discuss a payment deduction with me. Good news, I think!

@tarheels,

Ask to be cced on all correspondence.

TarheelsInNj said:

I heard back from the office in response to my letter, and they said they did verify the benefits and were told that the orthotics were covered. They're going to appeal and if that doesn't work, they'll discuss a payment deduction with me. Good news, I think!

Hey, that is a very good thing! Hope it works out for you.

It looks like Aetna denied the podiatrist's appeal. Sigh. They are saying it's not a covered benefit under the plan, the same as the original claim denial.

So, basically, the podiatrist is now saying it's up to me. I've sent an appeal in to Aetna myself but I'm not particularly hopeful. Once I receive a "no" I guess I'll try to get them to at least accept the amount that WOULD have been paid to them by Aetna, which is a little lower.

Same thing happened to us when one of our kids was born.  The OB/GYN called in a specialist to observe and he was out of network.  Next thing I know, we get a bill for almost $500 for 10 minutes of this guy's time. I fought it and appealed, my insurance company ended up covering it. 

PeggyC said:

The out of network thing happened to me a couple of years ago when I had a sonogram done on my throat and the doctor I was working with wanted a specialist to read the resulting report. No one asked me to give the okay when they chose a doctor to review the results, and I ended up with a $500 bill my insurance wouldn't cover. 

Regarding the podiatrist issue, have you tried talking to the doctor himself, rather than the officer manager/billing person? I had a problem with a similar issue with my ENT specialist years ago, and the office manager kept billing me for something I knew was b.s., but they would not relent. I raised the issue with the doctor herself during an exam, and she said, "Don't pay it. I'll take care of that." Never heard from the office again.

I still think it is important to take it up with the doctor himself. The practice manager and billing department will stick to their guns come hell or high water, but the doctor might be willing to cut you some slack, or let it go. I have done this successfully with an ENT practice when I was such a regular they all knew me on a first name basis.

Have the orthotics helped you?

Whenever I have had problems with my insurance, I sent a complaint to the state insurance board....i skipped appeals because they were always denied....but these were always things clearly covered....like an annual physical....it wouldn't hurt to try that route.

Tom_Reingold said:

Have the orthotics helped you?

It's honestly hard to say. I didn't go in with a critical problem to start. It was more of a proactive thing. I'm a runner and was having a sometimes-pain. I still have it, sometimes. It hasn't gotten worse so I guess that's something?