How to properly dispute Emergency Room bill

[AnthonyJ]

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

I am not sure if I am posting this in the correct forum. I want to refuse to pay a bill for a hospital emergency room visit on the grounds that the visit I was directed to make by my daughter's urology specialist was unnecessary and wasteful. They only perfomed simple lab tests we could have had done at her pediatricians office for a fraction of the cost. I have included the background for this below. This is part of a letter I plan to send to the hospial's billing department. Note that I have already paid the ER physician's bill and will pay for the lab work as well. Also note that the urologist is on staff at the hospital we were directed to take her to.

Is this the proper approach to disputing this bill? Should I contact a lawyer first. What can the hospital do if I refuse to pay?

Thanks for your advice

EDIT: Please note we are disputing the ER charges ONLY. We have no problem paying the ER doctor or lab fees


Background:

Our daughter has a history of kidney and bladder issues for which she has been treated by Dr. (urologist). On June 2, 2009 she had abdominal pain and blood in her urine. We took her to her pediatrician, Dr. (pediatrician), and he ran a urine test. He scheduled a renal ultrasound to be performed at (hospital) on June 18, 2009 as that was the first available appointment. By June 18, 2009 she no longer had pain or any blood in her urine. She was feeling fine, but we decided it was best to have the scheduled ultrasound performed anyway. The day after the test we called Dr. (urologist) office for the test results and spoke with his receptionist. The receptionist told us that the ultrasound results were abnormal and that she would contact Dr. (urologist) immediately as he was leaving for a vacation. She called back and told us that Dr. (urologist) was concerned with the results. She told us that he wanted our daughter to be seen immediately by the resident urologist at (hospital). She said that we should take her through the ER and that the doctors would be informed of her condition as well as the tests that Dr. (urologist) felt would be necessary. She told us that they would probably perform a CAT scan or MRI. We questioned the urgency because our daughter was feeling fine and no longer had the symptoms she had been experiencing two weeks earlier when this episode began. We were told that it was urgent and that we needed to go to the ER immediately.

When our daughter was admitted to the ER that day it soon became apparent that no pre-arrangements had been made. We had to repeatedly explain why we were there to the doctors and nurses that came into her room. She had no pain or symptoms of infection so I assume it was an odd case for them. We explained repeatedly that Dr. (urologist) office had directed us to come to the ER for tests that he felt were necessary. We told them that she felt fine but that we were directed by her doctor to come to the ER.

The nurses took blood and urine for testing and then we sat for hours. At one point a nurse told us that they were going to take our daughter for an X-Ray. We told her that we felt that an X-Ray was redundant and unnecessary because she had just had a renal ultrasound performed on the previous day. We suspected that we were just “in the system”, and that no instructions had been left with the ER staff. We knew at that point that this was going to be an extremely expensive visit for simple lab tests that could have been performed down the street from our house for a small fraction of the cost of an ER visit. We asked what instructions were given from Dr. (urologist) and if the resident urologist had been informed. No answer was provided. At this point my wife walked over to Dr. (urologist) office to try to determine what instructions had been given. Dr. (urologist) nurse followed her back to the ER and spoke with the staff. Shortly thereafter, the resident urologist came to our daughter’s room and told us that her urine test looked fine. He said that the initial concern was over a size difference between her two kidneys. He told us that the difference was actually within normal range and was not of concern. At this point we told the doctor that we wanted to leave and that enough time, money, and fear in the heart of our nine year old daughter had been wasted. Dr. (ER physician) came to our daughter’s room and we told her what we had experienced that day. We told her that we would agree to pay for the lab tests that had been performed but that we would not pay for the ER visit because it was obviously unwarranted. She was sympathetic to our opinion and told us that she would discuss the matter with her director, Dr. (ER Director).

A bill for over $1500 has been submitted to our medical insurance company for this ER visit. With our deductable and co-pay we will personally be billed nearly $1000 for what amounts to simple blood and urine tests. Under no circumstances will we pay this bill. In over 25 years of marriage my wife and I have never left any kind of bill unpaid, nor have we ever paid a bill late. Our credit score over 800 reflects our financial responsibility and our determination to “do the right thing”.

In the case of this ER visit we ask that you “do the right thing” and reverse the charges for this visit.

Thank youWhat is the name of your state (only U.S. law)?

 

[Isis1]

while you were in the emergency room, did you consent to the testing?

 

[Zigner]

You are responsible for the ER bill. Your beef (if any) would be with the referring doctor.

Say your normal mechanic tells you to rush to the dealer for diagnosis of an engine problem that has the potential to destroy the engine. Then, the dealer performs all of the tests that you (through your normal mechanic) requested, and finds nothing wrong. Should the dealer be stiffed out of their payment? I think not.

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

I am not sure if I am posting this in the correct forum. I want to refuse to pay a bill for a hospital emergency room visit on the grounds that the visit I was directed to make by my daughter's urology specialist was unnecessary and wasteful. They only perfomed simple lab tests we could have had done at her pediatricians office for a fraction of the cost. I have included the background for this below. This is part of a letter I plan to send to the hospial's billing department. Note that I have already paid the ER physician's bill and will pay for the lab work as well. Also note that the urologist is on staff at the hospital we were directed to take her to.

Is this the proper approach to disputing this bill? Should I contact a lawyer first. What can the hospital do if I refuse to pay?

Thanks for your advice

Background:

Our daughter has a history of kidney and bladder issues for which she has been treated by Dr. (urologist). On June 2, 2009 she had abdominal pain and blood in her urine. We took her to her pediatrician, Dr. (pediatrician), and he ran a urine test. He scheduled a renal ultrasound to be performed at (hospital) on June 18, 2009 as that was the first available appointment. By June 18, 2009 she no longer had pain or any blood in her urine. She was feeling fine, but we decided it was best to have the scheduled ultrasound performed anyway. The day after the test we called Dr. (urologist) office for the test results and spoke with his receptionist. The receptionist told us that the ultrasound results were abnormal and that she would contact Dr. (urologist) immediately as he was leaving for a vacation. She called back and told us that Dr. (urologist) was concerned with the results. She told us that he wanted our daughter to be seen immediately by the resident urologist at (hospital). She said that we should take her through the ER and that the doctors would be informed of her condition as well as the tests that Dr. (urologist) felt would be necessary. She told us that they would probably perform a CAT scan or MRI. We questioned the urgency because our daughter was feeling fine and no longer had the symptoms she had been experiencing two weeks earlier when this episode began. We were told that it was urgent and that we needed to go to the ER immediately.

When our daughter was admitted to the ER that day it soon became apparent that no pre-arrangements had been made. We had to repeatedly explain why we were there to the doctors and nurses that came into her room. She had no pain or symptoms of infection so I assume it was an odd case for them. We explained repeatedly that Dr. (urologist) office had directed us to come to the ER for tests that he felt were necessary. We told them that she felt fine but that we were directed by her doctor to come to the ER.

The nurses took blood and urine for testing and then we sat for hours. At one point a nurse told us that they were going to take our daughter for an X-Ray. We told her that we felt that an X-Ray was redundant and unnecessary because she had just had a renal ultrasound performed on the previous day. We suspected that we were just “in the system”, and that no instructions had been left with the ER staff. We knew at that point that this was going to be an extremely expensive visit for simple lab tests that could have been performed down the street from our house for a small fraction of the cost of an ER visit. We asked what instructions were given from Dr. (urologist) and if the resident urologist had been informed. No answer was provided. At this point my wife walked over to Dr. (urologist) office to try to determine what instructions had been given. Dr. (urologist) nurse followed her back to the ER and spoke with the staff. Shortly thereafter, the resident urologist came to our daughter’s room and told us that her urine test looked fine. He said that the initial concern was over a size difference between her two kidneys. He told us that the difference was actually within normal range and was not of concern. At this point we told the doctor that we wanted to leave and that enough time, money, and fear in the heart of our nine year old daughter had been wasted. Dr. (ER physician) came to our daughter’s room and we told her what we had experienced that day. We told her that we would agree to pay for the lab tests that had been performed but that we would not pay for the ER visit because it was obviously unwarranted. She was sympathetic to our opinion and told us that she would discuss the matter with her director, Dr. (ER Director).

A bill for over $1500 has been submitted to our medical insurance company for this ER visit. With our deductable and co-pay we will personally be billed nearly $1000 for what amounts to simple blood and urine tests. Under no circumstances will we pay this bill. In over 25 years of marriage my wife and I have never left any kind of bill unpaid, nor have we ever paid a bill late. Our credit score over 800 reflects our financial responsibility and our determination to “do the right thing”.

In the case of this ER visit we ask that you “do the right thing” and reverse the charges for this visit.

Thank youWhat is the name of your state (only U.S. law)?

 

[AnthonyJ]

while you were in the emergency room, did you consent to the testing?

yes we consented to the blood and urine tests. We refused the X-ray. We have agreed to pay for the lab tests. We are disputing only ER charges.

 

[ecmst12]

You didn't go to the pediatrician's office. You went to the ER and have to pay for ER services. If it wasn't necessary, why did you go? You received the services and now must pay for them. Services provided on an emergency basis are ALWAYS more expensive then non-emergency services because the fees are to support the entire infrastructure necessary to provide emergency services. Think of everything a hospital needs to operate 24 hours a day, 7 days a week. Expensive, don't you think?

Additionally, sometimes when a bladder infection progresses to a kidney infection, the symptoms will briefly go away and the patient will feel ok for a while. This is a very dangerous time as the infection is still progressing and can result in serious consequences if treatment is not continued. I'm sure this is what the urologist was trying to avoid.

 

[ElvinMelvin]

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

I am not sure if I am posting this in the correct forum. I want to refuse to pay a bill for a hospital emergency room visit on the grounds that the visit I was directed to make by my daughter's urology specialist was unnecessary and wasteful.

You went to the ER on the advice of your daughter's doctor, presumably because you respect his opinion.

The ER staff did a thorough workup on her, as they are supposed to do, and you agreed to it.

They have now charged you for it. You think that it's too expensive for what they did.

OK.

My brother-in-law recommended a restaurant to me, and I respect his opinion.

I went and they cooked me a meal there, which they are supposed to do, and I ate it.

Then I got the bill. I thought it was too expensive for what I got.

Is there some reason I should be required to pay and you should not?

You could have left at any time. You could have gone to the clinic on the corner and gotten the tests for cheaper. But you didn't. You used the ER, the most expensive care provided in the US. So pay up.

 

[AnthonyJ]

My arguement is that the urologist told us that this was an emergency when it very obviously was not. He did not leave any instructions with the ER and nothing was done that could not have been done via a normal doctor visit. Why did he direct us to go to the ER instead of telling us to go to her pediatrician?

 

[Zigner]

My arguement is that the urologist told us that this was an emergency when it very obviously was not. He did not leave any instructions with the ER and nothing was done that could not have been done via a normal doctor visit. Why did he direct us to go to the ER instead of telling us to go to her pediatrician?

Regardless of the answer to your questions, the ER is definitely not the bad guy here. They deserve to be paid.

 

[ecmst12]

You should definitely ask the urologist why he didn't make the arrangements he said he would. Wouldn't likey change the bill since you would have still gone to the ER and had services through there. And since you were seen by the specialist at the hospital, not much would have changed. Your urologist clearly thought the results were concerning and needed urgent follow up. It turned out nothing was wrong which is great but he didn't KNOW that nothing was wrong and could not have known until the follow up tests were done! So if it turned out there WAS something wrong and he had told you to follow up with PCP at your convenience and your daughter ended up getting sicker or worse, how would you feel then? Doctors do and should err on the side of caution more often then not, and that is a GOOD THING.

 

[AnthonyJ]

Regardless of the answer to your questions, the ER is definitely not the bad guy here. They deserve to be paid.

Can the urologist be sued for the ER expense? He was leaving for vacation and did not give due diligence to the ultra-sound results from the previous day. This fact was confirmed by the resident urologist who told us that those results where in normal range and was also perplexed as to why we had come to the ER.

 

[Zigner]

Can the urologist be sued for the ER expense? He was leaving for vacation and did not give due diligence to the ultra-sound results from the previous day. This fact was confirmed by the resident urologist who told us that those results where in normal range and was also perplexed as to why we had come to the ER.

Yes, he can be sued. The likelihood of you being successful in such a suit is virtually nil.

 

[lealea1005]

My arguement is that the urologist told us that this was an emergency when it very obviously was not. He did not leave any instructions with the ER and nothing was done that could not have been done via a normal doctor visit. Why did he direct us to go to the ER instead of telling us to go to her pediatrician?

Your 9 year old has a previous medical history of kidney issues which, as you know, can turn very serious in a very short period of time. The results of the Ultrasound were reported to her Urologist as "abnormal". The fact that the abnormality was a size difference of her kidneys made it even more emergent. You were appropriately referred to the ER for further testing for a difinative diagnosis. The interpretation of the US is only as good as the Radiologist who reads, then reports it. It's anyone's guess as to why the information wasn't communicated to the Urology resident.

No one knew the ER was ultimately not necessary until further testing or another pair of eyes looked at the actual ultrasound.

Glad your daughter is doing better.

 

[divona2000]

...The day after the test we called Dr. (urologist) office for the test results and spoke with his receptionist. The receptionist told us that the ultrasound results were abnormal and that she would contact Dr. (urologist) immediately as he was leaving for a vacation. She called back and told us that Dr. (urologist) was concerned with the results. She told us that he wanted our daughter to be seen immediately by the resident urologist at (hospital). She said that we should take her through the ER and that the doctors would be informed of her condition as well as the tests that Dr. (urologist) felt would be necessary. She told us ...

...my wife walked over to Dr. (urologist) office to try to determine what instructions had been given...

...My arguement is that the urologist told us that this was an emergency when it very obviously was not. He did not leave any instructions with the ER...

Have you actually spoken with Dr. (urologist) yet?
All the instructions you were given came from the receptionist...since no notice was given to ER, maybe she was supposed to tell you take to daughter to ER only if she got worse...?

 

[ajkroy]

You admit that your portion of the bill would be nearly $1000 because of the deductible. If you don't pay the hospital, the deductible portion of your insurance will not be covered by you, per your contract with the insurance. This may be considered insurance fraud.

 

[lealea1005]

You admit that your portion of the bill would be nearly $1000 because of the deductible. If you don't pay the hospital, the deductible portion of your insurance will not be covered by you, per your contract with the insurance. This may be considered insurance fraud.

Good point! Something you may want to think about, OP.