medical debt collection - double billing practice of uninsured patients

[famille16]

What is the name of your state (only U.S. law)? KS

A local out-patient surgery center provided services for a knee arthroscopic procedure (partial medial meniscectomy - billing code 29881)

In the fine print of the "Informed Consent to Treat" section a paragraph reads, "I hereby consent to the performance of operations and procedures in addition to or different from those now planned whether or not arising from presently foreseen conditions, which the doctor named below or his associates or assistants may consider necessary or advisable during the operation procedure."

I am uninsured and thus was required to pay in advance the sum of $2,810.00 for the surgery center services for the planned procedure. The reason I chose this center is that they had a special discount for uninsured patients, reducing the bill to $702.50 which I paid in full prior to the procedure. The out-patient surgery center subsequently billed me an additional $3,580.00 for a second procedure that the surgeon performed: an arthroscopic knee deburring/shaving procedure, but then offered to reduce it to $895 which they said is their uninsured client rate.

I called the physician to ask about this added procedure inasmuch as he did NOT bill me for this additional service, nor did the anesthesia services company. He said it only took about 10-15 minutes and he usually does not bill for it. He was surprised that the out-patient center was billing me for it as an entirely separate procedure. And that when they do, they normally accept an "insurance only" payment, saving the patient additional expense.

I called the out-patient surgery center and was told they expected payment in full and that they would not negotiate a reduced payment for the second procedure even though it took only 10-15 minutes additional time to the planned surgery procedure. They further said they had already reduced the bill so they couldn't understand my complaint.

I said that I would not pay the full amount ($895), but that I would pay a portion to compensate them for their extra time during surgery. They said they would sue me for the full balance of the billing.

I did a little research on whether insurance companies and/or medicare/medicaid will pay for this second procedure (billing code 29877). My research suggest that they will not pay for it (which is why the surgery center may have the additional language in their consent form?)

I resolved that if the surgery center sued me, my defense would be the practice of insurance and medicare to refuse payment on the additional procedure (29877), especially if it occurred in the same knee area of the first planned surgery, and the absence of any second billing by either the surgeon or the anesthetist.

I received a letter from a law firm stating their intent to sue to which I responded briefly replied to stating my objection to their client's double billing procedure.

I received today a summons of a lawsuit filed by the surgery center in this matter. Do I have a case if the surgery center cannot get insurance or medicare to pay for this second 10-15 minute procedure that requires little if any additional service save 15 minutes of extra time, but will bully an uninsured patient to cough up even more money than was billed for the original procedure?

By the way, the surgery center staff encouraged me to take as much time in recovery as I might need, and when I did, they did not bill me for the additional recovery time I took in their center.

P.S. As might be imagined, I would not go back to this surgery center again, nor have any of my family go there. When my 13 year old daughter needed minor surgery last month (c. $2,200), we went to a different center where I refused to sign any form until they assured my verbally and in writing that would not bill a second procedure should the surgeon need to do anything additional to the planned surgery. When I briefly shared my knee surgery experience they said that they considered such a second billing procedure to be unethical, and that they would never do that.What is the name of your state (only U.S. law)?

[ecmst12]

Usually additional procedures are paid at a reduced rate, not necessarily denied totally. But that depends on the specific procedures being bundled. Also depends on the provider being contracted with an insurance company or agreeing to accept medicare's adjudication, which does not affect you. They are not required to give an uninsured patient the same consideration that they give to insurance companies that provide them with hundreds or thousands of patients every year. I can't tell you what your chances of winning this suit are, but I think you should have talked to a lawyer to find out before you let it get this far! At any rate you should definitely hire one now, the legal research and arguments that will be needed to win this case are beyond the scope of most lay people.

[Some Random Guy]

1. You agreed to pay for additional work performed which your doctor deemed necessary.
2. Your doctor (not the surgery center) deemed it necessary to perform a deburring procedure
3. The work was performed using the surgery center facilities.

Its extremely clear cut. Because you wouldn't pay the recuced amount you are now being sued for thefull amount and the cost of collection. If you didn't want any additional work, then you should have made that clear with your surgeon. The surgery center did not chose to perform the work but their facilities and tools and insurance premiums were used.