Mis-representation???

[lisa beth]

I recently saw a Doctor in my state(NJ) who advised me that I required certain treatments to correct an issue. He told me that my insurance would be billed at a higher rate to cover their cost so instead he gave me a discount price for out of pocket price on a payment plan. The arrangement was for 9 months at an agreed price for 12 visits per month. There wasn't any fine print to indicate being penalized for cancellation or early termination of services or even price adjustments. However, I recently told him that I was going to have the issue dealt with another way & wanted a refund for the balance of visits that were paid.
His position is that he wants to adjust the price given to reflect a standard office visit price. Thus the visits that I already paid for as part of the payment plan would be increased along with any other services that he performed!!! I mentioned earlier that none of what he is saying was ever discussed or is it written anywhere in the Office!! I need to find out how to handle this situation..I have to meet with him next week as he wants to pull my chart to get more information.

 

[tranquility]

While I'd certainly negotiate with the doctor, in the end you will have to pay them.

Either you had a contract with a reduced rate or you did not. Now, I'd say you didn't because you had an improper purpose for the contract (cheat the insurance company), but that is not really important.

If you had a contract, you breached the contract and owe the doctor for the entire series. If you didn't have a contract, then you don't have the right to expect the reduced price.

 

[swalsh411]

The reduced price was offered with the understanding that you would be receiving a certain number of treatments over the course. In other words you got a volume discount. It's entirely reasonable that this discount should be retracted considering you chose to end the treatments early.

If you hired a caterer who normally charges $20 a person but agreed to charge you only $15 per person because you were feeding 1,000 people, but you changed your mind at the last minute and said you were only feeding 100, would you still expect to get the reduced price?

Oh and you also both committed insurance fraud! Way to go!

 

[lisa beth]

Thanks for the responses. How can Insurance fraud be committed when they never submitted a claim to the insurance company!! The doctor stated that it was in my best interest to pay him out of pocket as IF he submitted a claim to the insurance company I would pay more money as co-payment than if he billed me directly. The latter scenario was accepted. My apologies if this was not made clear in my initial posting. The insurance company never got involved..

 

[swalsh411]

My bad. I thought you were saying he would bill the insurance company for a more expensive treatment then you were actually receiving. I still think he has a claim though that you agreed to a certain number of treatments.