A bill from the doctor - how/should I contest?

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stlbrucefan
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A bill from the doctor - how/should I contest?

Post by stlbrucefan » Fri Feb 09, 2018 2:07 pm

My wife received a bill from her doctor for a service that was provided exactly one year ago today, saying that we owe $300. We absolutely will pay what we owe, but I have a few issues with this bill....

1. When I called today to ask what the bill is for, it was explained to me that it was for "behind the scenes" services that they charge for that is not directly related to any specific care/tests that she received.

2. At the time, our insurance did not cover these dr. visits (fertility treatment). Because of this, I called in advance to speak to the secretary about all of our charges. Never once was this "behind the scenes charge" mentioned.

3. We paid our "last" bill to the dr office last October. When they payment was made, we were told that we had no outstanding balance and we had paid for everything in full.

4. This is a year old.

Do I have a leg to stand on here? We absolutely loved our doctor and have recommended several friends to her, but I'd have a hard time continuing this if I have to tell them that they have to be very, very careful about staying on top of bills they receive. I called this morning and made my case that we feel this charge should be waived. They are going to call me back.

Any thoughts? Am I right to contest this? You won't hurt my feelings if you tell me to suck it up.

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Alexa9
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Re: A bill from the doctor - how/should I contest?

Post by Alexa9 » Fri Feb 09, 2018 2:09 pm

That sounds like a poor explanation for the bill although it doesn't mean it is phony. I'd wait and see what they say.

wilshuer
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Re: A bill from the doctor - how/should I contest?

Post by wilshuer » Fri Feb 09, 2018 2:15 pm

That's a tough one, especially with what seems like poor documentation and poor explanation. I would challenge it, especially on the basis that you've given them business based on recommendations - be sure to highlight that. Perhaps it will be waived simply as a referral bonus.

On a side note, I'm hoping you were successful on the fertility side. My wife and I had a long journey that ended in success.

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flamesabers
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Re: A bill from the doctor - how/should I contest?

Post by flamesabers » Fri Feb 09, 2018 2:49 pm

I think you are right to contest this bill. Failure to bill you correctly and in a timely manner is their problem, not yours.

Not getting a detailed explanation for what the bill is for is a huge red flag I think. Saying "it's for behind the scenes services" I think is another way of saying we want to charge you for something that you can't prove you already paid for. Since they say you still owe them money, they should be able to tell you what services/goods you haven't paid for. If they can't, how can you know whether this is a legitimate bill or not?
stlbrucefan wrote:
Fri Feb 09, 2018 2:07 pm
3. We paid our "last" bill to the dr office last October. When they payment was made, we were told that we had no outstanding balance and we had paid for everything in full.
Did you get this in writing?

neveragain
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Re: A bill from the doctor - how/should I contest?

Post by neveragain » Fri Feb 09, 2018 3:05 pm

I would contest the bill. I see it as a grab for more money from their patients. Infertility patients are often seen as cash cows by the medical profession. I went through this myself for years. Saying something is "behind the scenes" is not a sufficient explanation.

If for some reason, you do pay the bill, write "PAID IN FULL" on the memo line of the check you write. This can help to prevent them from attempting to bill you for anything else.

stlbrucefan
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Re: A bill from the doctor - how/should I contest?

Post by stlbrucefan » Fri Feb 09, 2018 3:09 pm

flamesabers wrote:
Fri Feb 09, 2018 2:49 pm
I think you are right to contest this bill. Failure to bill you correctly and in a timely manner is their problem, not yours.

Not getting a detailed explanation for what the bill is for is a huge red flag I think. Saying "it's for behind the scenes services" I think is another way of saying we want to charge you for something that you can't prove you already paid for. Since they say you still owe them money, they should be able to tell you what services/goods you haven't paid for. If they can't, how can you know whether this is a legitimate bill or not?
stlbrucefan wrote:
Fri Feb 09, 2018 2:07 pm
3. We paid our "last" bill to the dr office last October. When they payment was made, we were told that we had no outstanding balance and we had paid for everything in full.
Did you get this in writing?
No, but the lady that I spoke to today was the same lady that told me I was paid in full, and she admitted on the phone today that she remembers our conversation and that it was an error on her part. She said we technically were paid in full at the time but that this remaining balance was currently going through insurance. I told her that was not specified at the time, and she admitted that it was her mistake.

stlbrucefan
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Re: A bill from the doctor - how/should I contest?

Post by stlbrucefan » Fri Feb 09, 2018 3:11 pm

wilshuer wrote:
Fri Feb 09, 2018 2:15 pm
That's a tough one, especially with what seems like poor documentation and poor explanation. I would challenge it, especially on the basis that you've given them business based on recommendations - be sure to highlight that. Perhaps it will be waived simply as a referral bonus.

On a side note, I'm hoping you were successful on the fertility side. My wife and I had a long journey that ended in success.
I appreciate that. It was doubly successful......we currently have identical twin girls in our home. That's why I need this $300!!

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flamesabers
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Re: A bill from the doctor - how/should I contest?

Post by flamesabers » Fri Feb 09, 2018 3:17 pm

stlbrucefan wrote:
Fri Feb 09, 2018 3:09 pm
flamesabers wrote:
Fri Feb 09, 2018 2:49 pm
I think you are right to contest this bill. Failure to bill you correctly and in a timely manner is their problem, not yours.

Not getting a detailed explanation for what the bill is for is a huge red flag I think. Saying "it's for behind the scenes services" I think is another way of saying we want to charge you for something that you can't prove you already paid for. Since they say you still owe them money, they should be able to tell you what services/goods you haven't paid for. If they can't, how can you know whether this is a legitimate bill or not?
stlbrucefan wrote:
Fri Feb 09, 2018 2:07 pm
3. We paid our "last" bill to the dr office last October. When they payment was made, we were told that we had no outstanding balance and we had paid for everything in full.
Did you get this in writing?
No, but the lady that I spoke to today was the same lady that told me I was paid in full, and she admitted on the phone today that she remembers our conversation and that it was an error on her part. She said we technically were paid in full at the time but that this remaining balance was currently going through insurance. I told her that was not specified at the time, and she admitted that it was her mistake.
Since your insurance doesn't cover fertility treatments, why would the remaining balance be going through insurance? :confused

If you're going to continue to do business with this doctor's office, I think it's best you get everything in writing in regards to billing.

wilshuer
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Re: A bill from the doctor - how/should I contest?

Post by wilshuer » Fri Feb 09, 2018 3:22 pm

stlbrucefan wrote:
Fri Feb 09, 2018 3:11 pm
wilshuer wrote:
Fri Feb 09, 2018 2:15 pm
That's a tough one, especially with what seems like poor documentation and poor explanation. I would challenge it, especially on the basis that you've given them business based on recommendations - be sure to highlight that. Perhaps it will be waived simply as a referral bonus.

On a side note, I'm hoping you were successful on the fertility side. My wife and I had a long journey that ended in success.
I appreciate that. It was doubly successful......we currently have identical twin girls in our home. That's why I need this $300!!
:sharebeer Congrats, we ended up with twin boys, now 6. Being the boglehead mindset, I looked at it as buy one get one free. When one is acting up, we like to remind him he was the free one.

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Artful Dodger
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Re: A bill from the doctor - how/should I contest?

Post by Artful Dodger » Fri Feb 09, 2018 3:31 pm

If it was me, I would call the doctor, explain what you have listed here, and see what she says. Ultimately, this is her practice, and she can waive the bill. I can recall a few years ago my wife underwent a test that was supposed to be $300, but ended up being billed at $1800. My wife called her doctor, and she said don't worry about it.

This sounds like it is some type of overhead that should have been included in the price they quoted to you in the beginning. Maybe they decided to institute it after the initial treatment began, but forgot to inform you and now they're just catching it. Either way it just doesn't seem kosher.

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lthenderson
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Re: A bill from the doctor - how/should I contest?

Post by lthenderson » Fri Feb 09, 2018 4:20 pm

Like the others, I would probably contest it initially until I got a better answer. However, in the long run, I would probably pay the $300 versus having it turned over to collection agencies and such because the aggravation caused by that would be worse than being out $300.

Since it went through your insurance and I assume was denied by them, perhaps they might have some insight on the charge and what it was for. I might call them too just so see if they could shed some light on it.

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Re: A bill from the doctor - how/should I contest?

Post by Ivymd » Fri Feb 09, 2018 5:01 pm

Artful Dodger wrote:
Fri Feb 09, 2018 3:31 pm
If it was me, I would call the doctor, explain what you have listed here, and see what she says. Ultimately, this is her practice, and she can waive the bill. I can recall a few years ago my wife underwent a test that was supposed to be $300, but ended up being billed at $1800. My wife called her doctor, and she said don't worry about it.

This sounds like it is some type of overhead that should have been included in the price they quoted to you in the beginning. Maybe they decided to institute it after the initial treatment began, but forgot to inform you and now they're just catching it. Either way it just doesn't seem kosher.
I agree w Artful Dodger.
Call your doctor and explain the situation. Most likely the $300 bill will go away. At the very least, you'll get a better explanation for the 'back office' charges.

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Fri Feb 09, 2018 5:06 pm

No knowledge, experience or opinion - just amazed at the description of "behind the scenes". I wonder if there is a CPT code for that?

neveragain
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Re: A bill from the doctor - how/should I contest?

Post by neveragain » Fri Feb 09, 2018 5:13 pm

dm200 wrote:
Fri Feb 09, 2018 5:06 pm
No knowledge, experience or opinion - just amazed at the description of "behind the scenes". I wonder if there is a CPT code for that?
I'd want the code. But I likely wouldn't pay the bill and would contest it. I think it's a grab for money. I wouldn't be surprised if they're billing all their patients $300 to pay for a new piece of equipment in their office.

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DaftInvestor
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Re: A bill from the doctor - how/should I contest?

Post by DaftInvestor » Fri Feb 09, 2018 5:19 pm

I wouldn't lose sleep over it until they call you back.
There is a good chance they will just waive it.

johnubc
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Re: A bill from the doctor - how/should I contest?

Post by johnubc » Fri Feb 09, 2018 5:22 pm

I would not pay any bill for such a reason. They should be able to tell you exactly what the charges are for - I would also want to know the reason why there was such a delay in sending the bill. I would then decide if the charges are reasonable for the services stated.

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Fri Feb 09, 2018 5:24 pm

Hmmm . "fertility tretment" and "behind the scenes" .. Sounds like the plot from an episode of "Law and Order" :sharebeer

theplayer11
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Re: A bill from the doctor - how/should I contest?

Post by theplayer11 » Fri Feb 09, 2018 6:46 pm

state your referrals and future referrals and the bill will be waived.....guaranteed

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knpstr
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Re: A bill from the doctor - how/should I contest?

Post by knpstr » Fri Feb 09, 2018 7:06 pm

stlbrucefan wrote:
Fri Feb 09, 2018 3:09 pm
No, but the lady that I spoke to today was the same lady that told me I was paid in full, and she admitted on the phone today that she remembers our conversation and that it was an error on her part. She said we technically were paid in full at the time but that this remaining balance was currently going through insurance. I told her that was not specified at the time, and she admitted that it was her mistake.
That is one of the joys of insurance.

This sounds legitimate (that common process that all copays/deductibles paid (so Paid in full), rest goes to insurance, insurance doesn't pay, new bill to patient), but very poor communication on the offices part.
Very little is needed to make a happy life; it is all within yourself, in your way of thinking. -Marcus Aurelius

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Re: A bill from the doctor - how/should I contest?

Post by InMyDreams » Fri Feb 09, 2018 9:27 pm

dm200 wrote:
Fri Feb 09, 2018 5:06 pm
... just amazed at the description of "behind the scenes". I wonder if there is a CPT code for that?
Yeah, that's my thought too. Might be worth asking for one.

And reviewing the contract you have with them.

Not sure which regulatory authority you could mention, but I've found on at least two different occasions (one of which was healthcare insurance related) that mentioning the regulator caused things to become smoother. But you want whoever it is that regulates the medical practice. The local news consumer reporter might have fun with this? They love cute family pictures.

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Re: A bill from the doctor - how/should I contest?

Post by toofache32 » Fri Feb 09, 2018 11:05 pm

Ivymd wrote:
Fri Feb 09, 2018 5:01 pm
Artful Dodger wrote:
Fri Feb 09, 2018 3:31 pm
If it was me, I would call the doctor, explain what you have listed here, and see what she says. Ultimately, this is her practice, and she can waive the bill. I can recall a few years ago my wife underwent a test that was supposed to be $300, but ended up being billed at $1800. My wife called her doctor, and she said don't worry about it.
I agree w Artful Dodger.
Call your doctor and explain the situation. Most likely the $300 bill will go away. At the very least, you'll get a better explanation for the 'back office' charges.
What makes everyone think the doctor has anything to do with the billing? What makes everyone think the doctor is the boss? Maybe this doctor is one of the very few these days that still owns the practice, but the majority of doctors today have no control over this. They are like the airline pilots that play a critical role, but they don't own the plane and have no say in how much tickets cost.

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Re: A bill from the doctor - how/should I contest?

Post by Random Poster » Fri Feb 09, 2018 11:11 pm

toofache32 wrote:
Fri Feb 09, 2018 11:05 pm
Ivymd wrote:
Fri Feb 09, 2018 5:01 pm
Artful Dodger wrote:
Fri Feb 09, 2018 3:31 pm
If it was me, I would call the doctor, explain what you have listed here, and see what she says. Ultimately, this is her practice, and she can waive the bill. I can recall a few years ago my wife underwent a test that was supposed to be $300, but ended up being billed at $1800. My wife called her doctor, and she said don't worry about it.
I agree w Artful Dodger.
Call your doctor and explain the situation. Most likely the $300 bill will go away. At the very least, you'll get a better explanation for the 'back office' charges.
What makes everyone think the doctor has anything to do with the billing? What makes everyone think the doctor is the boss? Maybe this doctor is one of the very few these days that still owns the practice, but the majority of doctors today have no control over this. They are like the airline pilots that play a critical role, but they don't own the plane and have no say in how much tickets cost.
The OP says that they got a bill from the doctor.

Besides, I don't buy an airline ticket from the pilot, but from the airline. How do you buy your tickets?

toofache32
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Re: A bill from the doctor - how/should I contest?

Post by toofache32 » Fri Feb 09, 2018 11:17 pm

Based on the limited information here, I'm a doctor and I might contest this. Did you sign a financial agreement at the beginning which outlines the costs, etc? Before providing any treatment, the office should provide a financial estimate which includes a cost estimate that covers the total fees, insurance contribution and write-offs (in this case, zero) and an estimate for the patient's cost. We use an "estimate" because insurance companies often change their minds later and decide not to provide services despite a pre-authorization. But in this case it sounds like it was known that insurance would not pay. So the maximum amount of fees listed should be all you agreed to. If the office did not do this, they were stupid. If they did not give you a copy of the financial agreement, then a phone call to the office should be able to get you a copy of this contract mailed to you.

toofache32
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Re: A bill from the doctor - how/should I contest?

Post by toofache32 » Fri Feb 09, 2018 11:21 pm

Random Poster wrote:
Fri Feb 09, 2018 11:11 pm
toofache32 wrote:
Fri Feb 09, 2018 11:05 pm
Ivymd wrote:
Fri Feb 09, 2018 5:01 pm
Artful Dodger wrote:
Fri Feb 09, 2018 3:31 pm
If it was me, I would call the doctor, explain what you have listed here, and see what she says. Ultimately, this is her practice, and she can waive the bill. I can recall a few years ago my wife underwent a test that was supposed to be $300, but ended up being billed at $1800. My wife called her doctor, and she said don't worry about it.
I agree w Artful Dodger.
Call your doctor and explain the situation. Most likely the $300 bill will go away. At the very least, you'll get a better explanation for the 'back office' charges.
What makes everyone think the doctor has anything to do with the billing? What makes everyone think the doctor is the boss? Maybe this doctor is one of the very few these days that still owns the practice, but the majority of doctors today have no control over this. They are like the airline pilots that play a critical role, but they don't own the plane and have no say in how much tickets cost.
The OP says that they got a bill from the doctor.

Besides, I don't buy an airline ticket from the pilot, but from the airline. How do you buy your tickets?
From the airline. Similarly, you don't write a check to the doctor's name. You write it to the business (airline).
We don't yet know if the doctor is the boss/owner in this scenario, unless I missed it. Getting a bill "from the doctor" is from the business.

I have 2 jobs as a doctor. One is my private practice that I own. I do the hiring, firing, and make these decisions. In a case like this I would simply review the contract signed by the patient to see if they agreed to this. In my other job, I am an employee just like the nice lady at the front desk. When patient complain to me that they had to wait too long or the nurse was rude to them, I simply smile and say "I agree".

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Sat Feb 10, 2018 9:42 am

Post like this (very common here, unfortunately) make me so, so happy that DW and I have close to zero problems [ and zero of any significant nature]with bills, services, etc. from Kaiser.

In all seriousness, fighting, confusion and aggravation with this kind of thing is probably potentially harmful to your health.

mega317
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Re: A bill from the doctor - how/should I contest?

Post by mega317 » Sun Feb 11, 2018 3:18 am

Many threads here outlining how this has nothing to do with the physician. In my job I am told explicitly not to discuss money or billing at all, we have a readily available financial counselor (who is I'm sure great at obfuscation).

Unfortunately I don't think the fact you were told no more bills helps you. It's a mistake not a fraudulent statement.

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Sun Feb 11, 2018 9:47 am

mega317 wrote:
Sun Feb 11, 2018 3:18 am
Many threads here outlining how this has nothing to do with the physician. In my job I am told explicitly not to discuss money or billing at all, we have a readily available financial counselor (who is I'm sure great at obfuscation).
Unfortunately I don't think the fact you were told no more bills helps you. It's a mistake not a fraudulent statement.
OK - say it was a mistake. Seems odd that it would take a year to find some (to me) vaguely stated added charges.

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Re: A bill from the doctor - how/should I contest?

Post by mega317 » Sun Feb 11, 2018 9:59 am

Yeah I'm not saying it's legit or should be paid without question. Just that it doesn't matter what was previously said over the phone.

staythecourse
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Re: A bill from the doctor - how/should I contest?

Post by staythecourse » Sun Feb 11, 2018 11:00 am

Doc here.

Personally, I would not be satisfied from the situation thus far. They never gave you a direct answer to WHAT the charge is for. Just because insurance does not cover the service there should be a CPT code attached to the service. They can't just make up a charge for whatever they want. Also, even if it is legitimate are they in he 1 year window of when the service was provided to even charge for it? I believe the provider has ONE year to submit the charges to insurance.

In the end, the move I suggest is call the office and tell them you are more then happy to pay for the bill, but as customary practice you will pay once the bill is submitted to insurance and you get the EOB. Even if it is NOT covered by insurance it will be indicated as as service not covered by insurance. That doesn't mean it still should not be submitted.

Personally, this type of answer your received is what make ALL doctor's lose cred. with their patients. Not saying they are doing this, but what prevents them from sending the same bill to EVERY patient they have taken care saying the same thing whenever they are late on a mortgage payment or kid's tuition bill is up or they need some extra money to take that 1 week trip to Paris?

Good luck.
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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Sun Feb 11, 2018 11:18 am

mega317 wrote:
Sun Feb 11, 2018 9:59 am
Yeah I'm not saying it's legit or should be paid without question. Just that it doesn't matter what was previously said over the phone.
What can you depend on, then? Always ask for a written confirmation?

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Sun Feb 11, 2018 11:19 am

They can't just make up a charge for whatever they want.
Maybe they can?

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Re: A bill from the doctor - how/should I contest?

Post by staythecourse » Sun Feb 11, 2018 11:31 am

dm200 wrote:
Sun Feb 11, 2018 11:19 am
They can't just make up a charge for whatever they want.
Maybe they can?
There is an issue of needing to get consent (oral or written). If you are getting a procedure done it is ALWAYS written. Something like doing an office visit is oral as it is assumed making the appointment itself is an oral agreement to see the doctor to get an evaluation done. This is why it is important to know WHAT the bill is for so you can try to recollect or ask for documentation that you agreed to having x done.

One can't just make up whatever they want. I am POSITIVE the state AG would love to hear about if if that was the case.

Good luck.
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Re: A bill from the doctor - how/should I contest?

Post by Herekittykitty » Sun Feb 11, 2018 11:59 am

One wonders what is going to keep the doctor's office from sending more bills for "behind the scenes services" if the situation isn't resolved now. Indeed I would ask for the insurance EOB, the diagnostic code for the "behind the scenes services" and all associated documentation.

This may be able to be done in a collaborative way, but if not, I would still get it done, because if you just pay the bill without any of the above, you will never know what happened, and it could happen again, whatever the cause of it occurring.
I don't know anything.

mega317
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Re: A bill from the doctor - how/should I contest?

Post by mega317 » Sun Feb 11, 2018 12:08 pm

dm200 wrote:
Sun Feb 11, 2018 11:18 am
mega317 wrote:
Sun Feb 11, 2018 9:59 am
Yeah I'm not saying it's legit or should be paid without question. Just that it doesn't matter what was previously said over the phone.
What can you depend on, then? Always ask for a written confirmation?
IANAL but yeah. This isn't about medicine. If your mechanic from a year ago suddenly decided you owe more money, a prior phone conversation isn't going to help your case if you need to make one.

I think we need more info. It reads to me like the OP started expensive treatment, not covered by insurance, without fully understanding the costs. "I called in advance to speak to the secretary about all of our charges" is not sufficient. Again I'm not saying it's legit. We don't know enough about this.

Edit to clarify my point

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Re: A bill from the doctor - how/should I contest?

Post by bertilak » Sun Feb 11, 2018 1:00 pm

stlbrucefan wrote:
Fri Feb 09, 2018 2:07 pm
My wife received a bill from her doctor for a service that was provided exactly one year ago today, saying that we owe $300. We absolutely will pay what we owe, but I have a few issues with this bill....

1. When I called today to ask what the bill is for, it was explained to me that it was for "behind the scenes" services that they charge for that is not directly related to any specific care/tests that she received.

2. At the time, our insurance did not cover these dr. visits (fertility treatment). Because of this, I called in advance to speak to the secretary about all of our charges. Never once was this "behind the scenes charge" mentioned.

3. We paid our "last" bill to the dr office last October. When they payment was made, we were told that we had no outstanding balance and we had paid for everything in full.

4. This is a year old.

Do I have a leg to stand on here? We absolutely loved our doctor and have recommended several friends to her, but I'd have a hard time continuing this if I have to tell them that they have to be very, very careful about staying on top of bills they receive. I called this morning and made my case that we feel this charge should be waived. They are going to call me back.

Any thoughts? Am I right to contest this? You won't hurt my feelings if you tell me to suck it up.
I've had some experience in this area. The first is almost exactly like your situation. See note at bottom for final resolution.

First, a health care provider (I forget if it was hospital, lab, or doctor) was sending me regular bills for ongoing treatment, treatment that was finally finished. I paid every bill in full, including what I thought was the last bill, but got yet another bill for service dated well before my last bill. My opinion was that, being such old service, it should have been billed in a timely manner. I sent them a letter saying just that using words like "How am I to ever know when I have paid in full?" The charge was dropped* (see note below).

In another case a surgeon billed me for an "assistant surgeon" and insurance would not pay saying such a simple procedure did not justify an assistant. I called the surgeon's office and was told the "assistant" was observing as part of their residency (or some such). I said I was not about to pay for some student's education. Again, charges dropped.

Bottom line: State your objections clearly and concisely (without a lot of extraneous stuff, like anger or asking for pity) and, if reasonable, people will likely agree with you and straighten things out.

* note: It wasn't quite s simple as that. At first, I tried a phone call. It did not help so I wrote a letter stating the same thing and put a fictional lawyer on copy. THEN charges were dropped!
May neither drought nor rain nor blizzard disturb the joy juice in your gizzard. -- Squire Omar Barker, the Cowboy Poet

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Sun Feb 11, 2018 1:11 pm

In another case a surgeon billed me for an "assistant surgeon" and insurance would not pay saying such a simple procedure did not justify an assistant. I called the surgeon's office and was told the "assistant" was observing as part of their residency (or some such). I said I was not about to pay for some student's education. Again, charges dropped.
Without going into the medical details, I had significant neck surgery (not real happy with surgeon - but that is another story) and my insurance paid everything - no complications. The surgeon never mentioned another surgeon "participating", but I saw another surgeon's charges on the EOB and paid by the insurance company.

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Artful Dodger
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Re: A bill from the doctor - how/should I contest?

Post by Artful Dodger » Sun Feb 11, 2018 2:48 pm

bertilak wrote:
Sun Feb 11, 2018 1:00 pm
stlbrucefan wrote:
Fri Feb 09, 2018 2:07 pm
My wife received a bill from her doctor for a service that was provided exactly one year ago today, saying that we owe $300. We absolutely will pay what we owe, but I have a few issues with this bill....

My opinion was that, being such old service, it should have been billed in a timely manner. I sent them a letter saying just that using words like "How am I to ever know when I have paid in full?" The charge was dropped* (see note below).
I hadn't thought about timely filing. Most commercial insurers would have denied this for not meeting timely filing requirements. UHC limits to 90 days from DOS, Aetna to 120 days. The maximum is "exactly one year..." , as you wrote, or 365 days, which is Medicare's limit. However, even if it was billed in a timely fashion, undocumented "back room" charges would raise a flag with any claims administrator.

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Re: A bill from the doctor - how/should I contest?

Post by toofache32 » Sun Feb 11, 2018 3:08 pm

Those time limits are simply for the provider to file the claim. This does not include the time for the insurance to provide a response. There are multiple avenues they can delay this with requests for a "clean" claim, denials and multiple appeal levels which allow the insurance company to take 6-12 months or more for a response. When my office was in-network with medical insurance, my records was 18 months. It took me 18 months to get paid by insurance for a 10-hour surgery after appeals and all the hoops they make us jump through. I had a separate employee I hired just to appeal denials. This is why it became too expensive to take insurance so I dropped them. Couldn't be happier.

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Re: A bill from the doctor - how/should I contest?

Post by Mudpuppy » Sun Feb 11, 2018 3:36 pm

knpstr wrote:
Fri Feb 09, 2018 7:06 pm
stlbrucefan wrote:
Fri Feb 09, 2018 3:09 pm
No, but the lady that I spoke to today was the same lady that told me I was paid in full, and she admitted on the phone today that she remembers our conversation and that it was an error on her part. She said we technically were paid in full at the time but that this remaining balance was currently going through insurance. I told her that was not specified at the time, and she admitted that it was her mistake.
That is one of the joys of insurance.

This sounds legitimate (that common process that all copays/deductibles paid (so Paid in full), rest goes to insurance, insurance doesn't pay, new bill to patient), but very poor communication on the offices part.
If the charge was still pending at the insurance in October, the OP should have received an explanation of benefits (EOB) from the insurance between then and now stating that the charge was denied and what was the OP's responsibility to pay. Did the OP receive such an EOB?

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Re: A bill from the doctor - how/should I contest?

Post by stlbrucefan » Mon Feb 12, 2018 9:54 am

Mudpuppy wrote:
Sun Feb 11, 2018 3:36 pm
knpstr wrote:
Fri Feb 09, 2018 7:06 pm
stlbrucefan wrote:
Fri Feb 09, 2018 3:09 pm
No, but the lady that I spoke to today was the same lady that told me I was paid in full, and she admitted on the phone today that she remembers our conversation and that it was an error on her part. She said we technically were paid in full at the time but that this remaining balance was currently going through insurance. I told her that was not specified at the time, and she admitted that it was her mistake.
That is one of the joys of insurance.

This sounds legitimate (that common process that all copays/deductibles paid (so Paid in full), rest goes to insurance, insurance doesn't pay, new bill to patient), but very poor communication on the offices part.
If the charge was still pending at the insurance in October, the OP should have received an explanation of benefits (EOB) from the insurance between then and now stating that the charge was denied and what was the OP's responsibility to pay. Did the OP receive such an EOB?
No, I have never received an EOB for this specific charge. When I received the bill in the mail, it was the first I had heard of this charge, which was labeled "Cycle Management." When I asked on the phone what this was, that's when I was told it was the "behind the scenes" stuff that goes on in the office to ensure we receive quality care.

During January-February last year, our insurance did not cover fertility treatment (we switched plans in March), so we were paying everything out of pocket. Even with this being the case, the dr office recommending submitting those services to insurance to see if there would be any discounts applied (looking back, I see this was a futile waste of time.) Nonetheless, because all our visits would be out of pocket, I made sure to get CPT codes before each visit and spoke to the office laying out all of the charges for each visit. We never had any issues and everything was straightforward before we received this bill for $300. I have paid every bill we have received for them from January-February because I knew exactly what they were for. This one just seems sketchy to me.

I'm still waiting on a call-back from the office (I spoke to them on Friday). I'm going to give them another day (I know Mondays in offices can be busy) and then I will try again tomorrow. If they insist on me paying this bill, I'm going to contest and push back by 1)Asking for a CPT code so I can fully understand what this charge is...2)Mention that I have paid every bill on time because I communicated effectively with the office and knew each charge in advance, unlike this one...and 3)Stress that we loved our experience with our doctor and the office and have referred friends to them, but I will no longer do so in the future due to sketchy billing practices.

If you can think of anything else you would recommend saying or doing, I'm all ears. Thanks for all of the great replies.

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dm200
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Re: A bill from the doctor - how/should I contest?

Post by dm200 » Mon Feb 12, 2018 9:58 am

toofache32 wrote:
Sun Feb 11, 2018 3:08 pm
Those time limits are simply for the provider to file the claim. This does not include the time for the insurance to provide a response. There are multiple avenues they can delay this with requests for a "clean" claim, denials and multiple appeal levels which allow the insurance company to take 6-12 months or more for a response. When my office was in-network with medical insurance, my records was 18 months. It took me 18 months to get paid by insurance for a 10-hour surgery after appeals and all the hoops they make us jump through. I had a separate employee I hired just to appeal denials. This is why it became too expensive to take insurance so I dropped them. Couldn't be happier.
Back and forth between providers and insurance can go on for a long time. A few years ago, I had some surgery that is nearly identical to a cosmetic surgery. Mine was not cosmetic. The surgeon did not fully document the medical need initially and the back and forth between his office and my insurance went on for over a year until he was finally paid. Fortunately, I was not billed - and it all worked out.

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Re: A bill from the doctor - how/should I contest?

Post by BolderBoy » Mon Feb 12, 2018 7:12 pm

stlbrucefan wrote:
Fri Feb 09, 2018 2:07 pm
3. We paid our "last" bill to the dr office last October. When they payment was made, we were told that we had no outstanding balance and we had paid for everything in full.
You have a statement showing that your account is paid in full (zero balance outstanding)? You've received no further services since that statement?

I'd say that you owe nothing more.
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

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Re: A bill from the doctor - how/should I contest?

Post by stlbrucefan » Tue Feb 13, 2018 8:51 am

Quick update....I received a call from the dr. office last night saying that the bill would be waived. Thanks to all for your input and advice....everything worked out!

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Re: A bill from the doctor - how/should I contest?

Post by mega317 » Tue Feb 13, 2018 9:16 am

Glad it worked out! But did you ever get an explanation of the charge?

I would consider writing a negative review somewhere like Google reviews. It won't mean anything if they are the only game in town but if they have competition they will care about that. It might help future patients.

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Re: A bill from the doctor - how/should I contest?

Post by stlbrucefan » Thu Feb 15, 2018 10:21 am

From what I got out of the conversation, it is a legitimate charge that should have been explained back during the time of service but was not. It seems to me like they tried to slide it in after the fact, which I don't think is right. But at least they agreed to waive the charge in this case.

To me, it just reinforces the need to stay diligent on all medical bills. They are consistently wrong or not explained correctly, and almost always not in our favor. It's too bad in this case, because like I have said, our doctor and her staff were fantastic. Medical billing is just a nightmare, and it's a shame that we have to spend so much time and effort making sure they correct.

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