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Medical Bill Dispute

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jenesmith

Junior Member
What is the name of your state? GA

The following is an e-mail I sent to my doctor regarding the medical bill problem I was having.

Dear Dr. Matthew:
There's some inusrance issue with my last physical checkup. It turns out that my Aetna insurance didn't cover physical checkup last year (it's added this year). So I ended up owing the entire bill at premium rate (instead of the Aetna contract rate) for a totle of $400 ($300 from you and $100 from lab). even worse is: you've performed a complete physical check up for me in September, 2004, just one year earlier. The recommeded frequency for my age group is once every 2 years. This recommendation is also posted on the front page of your website. When I made the appointment last December, it was for papsmear. But when I walked in, you just went ahead did the complete physical. I went along with you because I thought it was covered by the insurance and it wouldn't hurt to do physical more frequently than the recommendation. Now I ended up holding the bag of $300 (I already paid $100 to the lab and they accepted the Aetna contract rate) for a completely unneccesary checkup. I wonder whether you can help me get the Aetna contract rate instead of the self-paying rate. If you can, I would pay the reduced rate in full immediately and my family will remain your loyal customers for a long time to come as we have been for the past 8 years. I would really appreciate your attention and help on this matter.


After I sent the email, I also walked in the clinic talked to the billing department and they plainly refused to make any compromise at all. I stormed out and told them that they will not get a single penny from me. But if they were willing to accept the Aeta contract rate, I would pay them in full right there. They ignored me. A few days later I received a letter from their collecting agency. The letter demanded me to pay in full within 30 days. Otherwise, they will take legal action. A couple of days later, I received a phone call from the collecting agent asking me whether I've eceived the letter, I said yes and informed him that I was in dispute with the clinic and explained the reason to him. Then he stopped pressing me and ended the call. It's been two weeks since that call and I haven't heard anything from them. As the 30 day limit getting closer, I'm getting uneasy about their silence. I think I will receive a court note. What should I do now? Am I reasonable for asking for the Aetna contract rate? Should I bite the bullet and pay the bill in full to avoid more financial damage from any legal expense?
 
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averad

Member
What is the contracted rate you are willing to pay, you fail to mention what you are offering.

You do mention that you knew he was performing additional services, yet you failed to question him. It is not the doctors responsibility to know your benefits or check them before performing medical services.

The fact you only made the appointment for a pap smear only might work in your favor, hopefully someone can comment on this for you.

In the end I believe you will be responsible for the bill based on the information you provided.
 
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jenesmith

Junior Member
The contract rate is about 40 to 50 percent off the self-paying rate. I feel that I ws pressured by the doctor to accept the service that was absolutely unneccesasary. The doctor knew me personally and he had my entire medical history pulled out on the scrren right in front of him when he was seeing me. I feel that he was as much responsible as I am, so I'm willing to pay half of my mistake, and the doctor should be pay his half of the mistake. Is that fair?
 

seniorjudge

Senior Member
jenesmith said:
The contract rate is about 40 to 50 percent off the self-paying rate. I feel that I ws pressured by the doctor to accept the service that was absolutely unneccesasary. The doctor knew me personally and he had my entire medical history pulled out on the scrren right in front of him when he was seeing me. I feel that he was as much responsible as I am, so I'm willing to pay half of my mistake, and the doctor should be pay his half of the mistake. Is that fair?
I feel that I ws pressured by the doctor to accept the service that was absolutely unneccesasary.

Your "feelings" are irrelevant in a court of law (should it get that far). Obviously, negotiate with the doctor, but there doesn't appear to be a mistake of any kind because you accepted the services.
 

jenesmith

Junior Member
Does that mean I can show up to the doctor's office and the doctor can do whatever he wants, neccessary or not, as long as I'm not screaming or running away from the doctor? Where does the doctor's professional judgement go? There are thousands of medical checkups and tests the doctor can run on me. Can they perform all of them on me as long as I don't firmly object to them? ( I did object, just not form enough)
By the way, this is exactly why American's medical cost is so out of control. Doctor tries to incur as much cost as possible on the patients.
 

seniorjudge

Senior Member
jenesmith said:
Does that mean I can show up to the doctor's office and the doctor can do whatever he wants, neccessary or not, as long as I'm not screaming or running away from the doctor? Where does the doctor's professional judgement go? There are thousands of medical checkups and tests the doctor can run on me. Can they perform all of them on me as long as I don't firmly object to them? ( I did object, just not form enough)
By the way, this is exactly why American's medical cost is so out of control. Doctor tries to incur as much cost as possible on the patients.
Q: Does that mean I can show up to the doctor's office and the doctor can do whatever he wants, neccessary or not, as long as I'm not screaming or running away from the doctor?

A: Exactly. Now you've got it. You are responsible for your own actions!
 

jenesmith

Junior Member
Averad:
I followed your link and read that thread. But that case is different from mine. Mine is physical checkup with no medical concern whatsoever. I don't think the doctor can just perform any routine checkup whenever they want without me complaining about symptoms first. In another word, the doctor should only perform a routine checkup following a schedule or due to a medical concern. Any arbitrary checkup (especially coercing the patient) is a rip-off
 

averad

Member
jenesmith said:
Averad:
I followed your link and read that thread. But that case is different from mine. Mine is physical checkup with no medical concern whatsoever. I don't think the doctor can just perform any routine checkup whenever they want without me complaining about symptoms first. In another word, the doctor should only perform a routine checkup following a schedule or due to a medical concern. Any arbitrary checkup (especially coercing the patient) is a rip-off
It was just to give you an example of additional responsibility for medical services.

You should pay the bill or enjoy a lower credit score. Threating not to pay is only going to get you into more problems unless you have the money laying around to fight this.
 

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