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wanttobeRAfree 
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Joined: 16 January 2008
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 Topic: OT- Dr. Charges
Posted: 10 May 2008 at 7:53am |
Opinions please-
My son's pediatrician charged me for a hearing test performed at my 18 year old's "routine" physical last year. My insurance did not cover it because they do not feel a hearing test is part of a routine physical. I did not know that a hearing test would be performed (he had no problems or symptoms to suggest such a test was needed).
So when I got the bill I wrote a letter and said I did not feel responsible for this charge and why.
Well- he wrote me the nastiest letter back saying it was my responsibility to know what my insurance covers and what it doesn't and sent me a waiver my husband had signed saying that we would pay for whatever charges our insurance doesn't cover- way back when.
I still have a problem with this. First of all my son was an 18 year old adult and attended the physical alone. He did not sign any waivers. #2 I certainly made sure my insurance covered a physical but how am I to know his office performs procedures that are not covered during a physical unless they tell me? #3 I recently read an article about how often hearing tests need to be performed and it wasn't necessary for my son to have one.
The letter he sent me was SO NASTY in tone I decided to pull both my son's from the practice and recently sent a request for the records to be forwarded to my doctor's practice- who is extremely patient friendly.
Today I got another bill. I think they are going to with hold the records unless I pay.
Do you think I should pay? If not and he is being unethical who do you report a doctor to in this situation?
Thanks.
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buckeye
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Posted: 10 May 2008 at 9:06am |
you should pay. I assume your husband is the primary person on your insurance, as a result his waiver signature covers all persons covered on his policy. it is your responsibility to know what your insurance pays not your doctors and if your son is still on your insurance policy and a dependent on your taxes then you are ultimately responsible for the charges at the doctor. If your son is an adult he pays his own charges. How do you know what the doctor performs as part of a physical ...you ask. How do you know what your insurance covers as a physical..you ask.
sorry...I'm with the doctor on this one.
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Suzanne
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Posted: 10 May 2008 at 9:24am |
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It sounds like the dr. has covered the bases on this one, so you are responsible and have learned the lesson the hard way, unfortunately. I think they could be nice about it, instead of rude, because I'm sure other patients will have this issue going forward.
Our ped does eye and ear exams every annual checkup, and so far it has been covered. A separate person does them, so I can see why a separate charge would come up. Since my JRA daughter sees a ped opth every three months, I refused the eye exam last time because it seemed unnecessary and the ped agreed. I don't know if it saved anybody any money, but it did save time.
I hope what you have communicated with them will at least make them more careful about letting patients know certain things might be covered up front. For example, when you make a well visit appt., they could say 'we like to do a vision and hearing screening that might not be covered, so please check with your insurer prior to the visit'. Then you could make an informed decision.
I bet insurers don't to want to cover them, now that so many schools do annual screenings?
Edited by Suzanne - 10 May 2008 at 9:25am
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Suzanne - mom of daughter w/jra
"There is nothing worse than aggressive stupidity." ~ Goethe
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MrsA_Again
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Posted: 10 May 2008 at 9:43am |
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Ouch. Sorry you got stuck with the bill and I understand why you don't think you should pay. However, it was a service the doctor provided and he does deserve to be reimbursed. He definitely did not have to be so rude though! You might try calling your insurance company to see if they can adjust the claim and if that doesn't work, speak with the billing department at the doctor's office to see if they can provide prompt pay discount for a balance paid in full.
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It's MrsA. I suck at saving passwords in places other than the pc.
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wanttobeRAfree
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Posted: 10 May 2008 at 9:47am |
Actually I am the primary person on the insurance
I agree with you Suzanne- when you make an appt. for a physical the office should say we do this or that test that might not be covered please check with your insurer.
They know from the tons of claims they submit what is and isn't covered. It's called being patient friendly.
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Whispered
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Posted: 10 May 2008 at 10:03am |
I wouldn't pay!! I think he was trying to milk money from you.. esp if his letter was that nasty.. and legally he has to send your patient records, to other drs..
I wouldn't and don't put up w/ that abuse... did you son say yes, to the hearing aid test?
If he's 18, then he might also be responsbile for this..
its a sticky situation... sigh... don't know...
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wanttobeRAfree
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Posted: 10 May 2008 at 10:13am |
whispered
My son wasn't asked- it was just performed. He didn't know any better to ask- hell I didn't know any better that I should have to ask if any procedures during the exam would not be considered "routine" Isn't that what a "routine" physical is?
I'll probably end up paying but I am going to send him the article that outlines time tables for hearing tests which this did not fit into and tell him he has a lot of nerve writing me in that kind of tone and that I hope the $45 is worth him losing 2 patients over. I'll tell him I am taking them to a doctor that has a proven record of having an office staff and doctor who are patient friendly. I don't pay for abuse!
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Lynn49
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Posted: 10 May 2008 at 10:14am |
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I think you should pay. I've always thought that it's my responsibility to know what my insurance does and does not cover..
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rocckyd
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Posted: 10 May 2008 at 10:43am |
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Have you talked to the insurance company? I got charged for a lead screening at my son's 4yr old checkup. Insurance said it was not necessary. All I knew was that every 4yr old I knew had had this done so I thought it was part of the routine physical. After talking to the insurance company they said that the office had keyed it in wrong. She changed the code and then it was covered. Something like the screening alone was not necessary but in conjuction with other things it was...whatever.
If it is still say it was not needed-then you gotta pay. I hate that your son is caught up in this but I guess it is a life lesson for him as well.
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Rebecca 34yrs
RA, Sjorgens, Lung Disease(caused by RA),Tachycardia: Currently taking Orencia,,Perocet, Pred.,Plaquenil,Mtx, Amytriptyline,flax seed,fish oil
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wanttobeRAfree
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Posted: 10 May 2008 at 10:43am |
I agree you that you need to know what your insurance covers but how far into detail do you have to go? I researched that a physical is covered on a yearly basis. I booked a physical- part of the physical was not covered. My insurance company did not tell me parts of a physical may not be covered- the doctor did not tell me parts of the physical may not be covered. The isurance company got paid their monthly premium, now the doctor got paid for the yearly physical from the insurance and is going to get paid by me for the unnecessary procedure performed.
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