Doctor trying to collect on disputed "procedure" - MI

[Barwick11]

What is the name of your state? MI

Nearly a year ago now, I went into a foot doctor for an office visit to have him take a look at a sore spot on my big toe (I thought it was an ingrown toenail). He looked at it and said "oh, it's not ingrown, it's just a little irritated and got a little infected, I can take care of that for you real quick if you want, no problem". I say "sure, go ahead" (seems to me like he's just going to take care of it as part of the office visit, he didn't make any indication otherwise). He comes back, drains a little bit of fluid, and put some neosporin-like gel on it. I go on my merry way.

Then, like 4 months later I get this bill for $215 in the mail (not the $15 co-pay for an office visit from my insurance). I look, and they're charging me $200 from what was left of the deductible for this "procedure" he did. I think back, and think "you've got to be kidding me".

I call them up, with my most absolutely best politest tone and try to work with them on it, saying that I dispute the "procedure", but nevertheless, if they want me to pay like $50 for it, I would. They woudln't budge one inch. Finally we go nowhere, and they send it to collections. I've talked to the collections agency, and they say "hey, talk to the doctor". I just called them up a few seconds ago, and the doctor wasn't available, but the lady in charge of collecting money for them is. She talks to the doctor and says "look, you knew it was more than just an office visit when he had to drain the infection and take a culture and sent it to the lab", I say "took a culture and sent it to the lab? really?" I didn't know about this part either.

But basically, I went in for an office visit to check out my foot to see if it was ingrown and needed anything serious done. It wasn't, and he said "it's just irritated and a little infected, I can fix it real quick no problem" as if he could just fix it as part of the office visit. Then all of a sudden I'm getting charged for a procedure? Had I known it was going to be separate, I would have opted to just do it myself at home (it really was no big deal, literally some alcohol to clean the area real good, a pinprick, and squeeze some junk out). But since he made it seem like the office visit would cover it, I had him do it.

I mean, I feel kinda like I went to meet a celebrity, shook their hand and they said "oh, by the way, that's going to be $50 for shaking my hand, I'll send you the bill".

So, I guess my question is, where do I go from here? They're trying to collect on it, and the collections agency is saying I'm responsible for it, unless the doctor's office says otherwise. So what should I do, and what are my chances of not getting screwed by these guys?

 

[Zigner]

So, I guess my question is, where do I go from here?

Ummm...
Pay your bill?

 

[lealea1005]

What is the name of your state? MI

Nearly a year ago now, I went into a foot doctor for an office visit to have him take a look at a sore spot on my big toe (I thought it was an ingrown toenail). He looked at it and said "oh, it's not ingrown, it's just a little irritated and got a little infected, I can take care of that for you real quick if you want, no problem". I say "sure, go ahead" (seems to me like he's just going to take care of it as part of the office visit, he didn't make any indication otherwise). He comes back, drains a little bit of fluid, and put some neosporin-like gel on it. I go on my merry way.

Then, like 4 months later I get this bill for $215 in the mail (not the $15 co-pay for an office visit from my insurance). I look, and they're charging me $200 from what was left of the deductible for this "procedure" he did. I think back, and think "you've got to be kidding me".

I call them up, with my most absolutely best politest tone and try to work with them on it, saying that I dispute the "procedure", but nevertheless, if they want me to pay like $50 for it, I would. They woudln't budge one inch. Finally we go nowhere, and they send it to collections. I've talked to the collections agency, and they say "hey, talk to the doctor". I just called them up a few seconds ago, and the doctor wasn't available, but the lady in charge of collecting money for them is. She talks to the doctor and says "look, you knew it was more than just an office visit when he had to drain the infection and take a culture and sent it to the lab", I say "took a culture and sent it to the lab? really?" I didn't know about this part either.

But basically, I went in for an office visit to check out my foot to see if it was ingrown and needed anything serious done. It wasn't, and he said "it's just irritated and a little infected, I can fix it real quick no problem" as if he could just fix it as part of the office visit. Then all of a sudden I'm getting charged for a procedure? Had I known it was going to be separate, I would have opted to just do it myself at home (it really was no big deal, literally some alcohol to clean the area real good, a pinprick, and squeeze some junk out). But since he made it seem like the office visit would cover it, I had him do it.

I mean, I feel kinda like I went to meet a celebrity, shook their hand and they said "oh, by the way, that's going to be $50 for shaking my hand, I'll send you the bill".

So, I guess my question is, where do I go from here? They're trying to collect on it, and the collections agency is saying I'm responsible for it, unless the doctor's office says otherwise. So what should I do, and what are my chances of not getting screwed by these guys?

Draining your infected toe IS a procedure. The amount applied to your deductible was probably already discounted from the total bill. The registration form you signed at the Doctor's office most likely indicated you were ultimately responsible for any fees your insurance company did not pay. You owe the bill.

 

[Barwick11]

So it's up to me to ask if every thing the doctor does is going to be a procedure? I'm supposed to know what's included in a standard office visit? What if he looks at my ankle as opposed to just a toe? Is that an extra charge? I mean, it's kinda ridiculous.

From my perspective, the doctor probably wasn't trying to be misleading, but he ended up doing so by making this "procedure" seem like it was no big deal, as if it could be taken care of as part of an office visit.

 

[seniorjudge]

Q: So it's up to me to ask if every thing the doctor does is going to be a procedure? I'm supposed to know what's included in a standard office visit? What if he looks at my ankle as opposed to just a toe? Is that an extra charge?

A: Yes; I think that is a pretty good way to put it.

 

[lealea1005]

So it's up to me to ask if every thing the doctor does is going to be a procedure? I'm supposed to know what's included in a standard office visit? What if he looks at my ankle as opposed to just a toe? Is that an extra charge? I mean, it's kinda ridiculous.

From my perspective, the doctor probably wasn't trying to be misleading, but he ended up doing so by making this "procedure" seem like it was no big deal, as if it could be taken care of as part of an office visit.

If the Doctor is examining your toe and just prescribes an antibiotic, it's an office visit.
When he makes an incision, drains an infection, cuts out an ingrown toenail, sutures a lacertion,etc., it's a procedure.

It is also up to you to be familiar with your insurance policy, your deductibles, and coverage.

 

[moburkes]

I agree with everyone else. This was not a regular office visit. It is not your doctor's job to know if your particular insurance policy will cover it. It is your job, though. The bill is legitimate, based on the information that you provided.

 

[barry1817]

foot

What is the name of your state? MI

Nearly a year ago now, I went into a foot doctor for an office visit to have him take a look at a sore spot on my big toe (I thought it was an ingrown toenail). He looked at it and said "oh, it's not ingrown, it's just a little irritated and got a little infected, I can take care of that for you real quick if you want, no problem". I say "sure, go ahead" (seems to me like he's just going to take care of it as part of the office visit, he didn't make any indication otherwise). He comes back, drains a little bit of fluid, and put some neosporin-like gel on it. I go on my merry way.

Then, like 4 months later I get this bill for $215 in the mail (not the $15 co-pay for an office visit from my insurance). I look, and they're charging me $200 from what was left of the deductible for this "procedure" he did. I think back, and think "you've got to be kidding me".

I call them up, with my most absolutely best politest tone and try to work with them on it, saying that I dispute the "procedure", but nevertheless, if they want me to pay like $50 for it, I would. They woudln't budge one inch. Finally we go nowhere, and they send it to collections. I've talked to the collections agency, and they say "hey, talk to the doctor". I just called them up a few seconds ago, and the doctor wasn't available, but the lady in charge of collecting money for them is. She talks to the doctor and says "look, you knew it was more than just an office visit when he had to drain the infection and take a culture and sent it to the lab", I say "took a culture and sent it to the lab? really?" I didn't know about this part either.

But basically, I went in for an office visit to check out my foot to see if it was ingrown and needed anything serious done. It wasn't, and he said "it's just irritated and a little infected, I can fix it real quick no problem" as if he could just fix it as part of the office visit. Then all of a sudden I'm getting charged for a procedure? Had I known it was going to be separate, I would have opted to just do it myself at home (it really was no big deal, literally some alcohol to clean the area real good, a pinprick, and squeeze some junk out). But since he made it seem like the office visit would cover it, I had him do it.

I mean, I feel kinda like I went to meet a celebrity, shook their hand and they said "oh, by the way, that's going to be $50 for shaking my hand, I'll send you the bill".

So, I guess my question is, where do I go from here? They're trying to collect on it, and the collections agency is saying I'm responsible for it, unless the doctor's office says otherwise. So what should I do, and what are my chances of not getting screwed by these guys?

surgical procedure without an informed consent?? most strange.

In some areas treatment without an informed consent can become very sticky for all parties involved. If I had a patient come into my office and told them it was a simple thing and hold on a second we'll get it taken care of I doubt that my bill would have been this high, but that was then.

[email protected]

 

[seniorjudge]

surgical procedure without an informed consent?? most strange.

In some areas treatment without an informed consent can become very sticky for all parties involved. If I had a patient come into my office and told them it was a simple thing and hold on a second we'll get it taken care of I doubt that my bill would have been this high, but that was then.

[email protected]

Why do you think you did not give informed consent?

 

[ellencee]

Informed consent is not an issue--but, that's not why I posted.

I want to know what in the heck the poster THOUGHT was going to happen if the toenail had been ingrown? get a kiss on his/her boo-boo?

The cost of removing an ingrown toenail would have been much higher, so really, the poster came out cheaper.

I guess most people still don't realize that cutting body part with a scapel is surgery (I'm talking healthcare related, guys) and used to be called simple or minor surgery but has morphed into now being called a "procedure" and each act such as a "procedure" has a code for which there is a nationally enforced minimum and maxium charge, unless the provider accepts only cash--then, the sky is the limit.

Pay the bill and follow Jamie Foxx's grandmother's advice and "act like you got some sense".

EC

 

[ecmst12]

Generally speaking, every separate thing that your doctor does when you go there is a separate charge. The examination is one charge, if he draws blood that's another, then the lab gets a charge when he sends the blood to them, etc. Even if he just used a needle(not a scalpel), it's still a procedure. You probably didn't know about the lab charges because a lot of insurance plans cover 100% of lab charges.

It may or may not be a separate charge if he examines more then one concern at a time; more likely it will just bump up the "level" of the office visit charge (from a 15 minute to a 30 minute exam, for example). If he had drained fluid from both big toes, that would have been 2 separate procedures though. The doctor does not have to get your individual approval on every charge that he bills, and you clearly consented to have the procedure done. You ASSUMED it was part of the office visit, but you didn't ask....that's not his fault.

This was your deductible though, now that it's paid you don't have to worry about it for the rest of the year. The charge was legitimate and not unreasonable, AND it's your responsibility, so you should pay it before it hurts your credit any more then it already has.

 

[Barwick11]

If the Doctor is examining your toe and just prescribes an antibiotic, it's an office visit.
When he makes an incision, drains an infection, cuts out an ingrown toenail, sutures a lacertion,etc., it's a procedure.

It is also up to you to be familiar with your insurance policy, your deductibles, and coverage.

He took a freaking pin and poked it, then a paper towel (no, wait, I think it was gauze, we're getting real in-depth here) and squeezed and dabbed it for about 3 seconds.

I AM familiar with my insurance policy and deductibles, that's why I would have elected to NOT get a procedure.

 

[Barwick11]

Informed consent is not an issue--but, that's not why I posted.

I want to know what in the heck the poster THOUGHT was going to happen if the toenail had been ingrown? get a kiss on his/her boo-boo?

The cost of removing an ingrown toenail would have been much higher, so really, the poster came out cheaper.

I guess most people still don't realize that cutting body part with a scapel is surgery (I'm talking healthcare related, guys) and used to be called simple or minor surgery but has morphed into now being called a "procedure" and each act such as a "procedure" has a code for which there is a nationally enforced minimum and maxium charge, unless the provider accepts only cash--then, the sky is the limit.

Pay the bill and follow Jamie Foxx's grandmother's advice and "act like you got some sense".

EC

If it was an ingrown toenail then I would have scheduled a procedure to be done. That's not something I can do by myself. But taking a freaking pin, poking a blister, dabbing it with some gauze, then putting neosporin on it? I can do that at home. And I went to him for an office visit to tell me if it was ingrown or not, and if I needed to have it removed. It didn't I was happy. But he offered to just take care of the problem right there and then, and I said "sure", because he made it seem like no big deal, definitely not a procedure.

 

[justalayman]

I doubt you will have any luck changing anything but a conversation with your insurance company may help explain things. Depending upon the doctor/insurance comapny's relationship is (legally), they may ne able to explain what they consider to be a procedure and is what you had done considered such (which all here seem to be in agrrement that it was).

Depending upon any contractual relationship they have, this may have been an improper billing and would have to be rescinded.

Chances are you are simply going to have to pay for the "procedure" but since you want to exhaust all options and exhaust everybody's patience, go for it.

 

[moburkes]

I doubt you will have any luck changing anything but a conversation with your insurance company may help explain things. Depending upon the doctor/insurance comapny's relationship is (legally), they may ne able to explain what they consider to be a procedure and is what you had done considered such (which all here seem to be in agrrement that it was).

Depending upon any contractual relationship they have, this may have been an improper billing and would have to be rescinded.

Chances are you are simply going to have to pay for the "procedure" but since you want to exhaust all options and exhaust everybody's patience, go for it.

Are you kidding me? I went to ER and was back in my car in 23 minutes. The doctor looked at my toe, and prescribed me an antibiotic. No procedure was done. The bill was $534. I paid it. It was for a service that was provided. Your definition of a procedure is different from the doctor's and the insurance company's definition of a procedure.