How do I handle my doctor's office's incompetence?

August 14, 2012 8:37 AM

My psychiatrist's office is behaving in an incompetent manner and I am furious. Aside from finding another doctor, how should I handle this?

Last week, I thought I had another refill left on my prescription, but when I looked at the bottle I realized I only had a few days left. On Wednesday, I called the doctor's office. They said I needed to make an appointment. I asked if my pharmacy could contact them about an immediate refill and they said yes. I contacted the pharmacy and they faxed their request.

After making the appointment, the doctor's office transferred me to their billing department. It seems that my doctor was NOT in network with my insurance, and I've racked up hundreds of dollars in fees since January, when I switched insurance companies (if it matters, it's through my husband's work). At that time, I had confirmed that she was listed on their website as being in network. I gave the doctor's office my new insurance information, and since January they've been taking my copays and billing the insurance company. In seven months, no one has told me that she was out of network (her certification or whatever was not renewed) or that the insurance company was not paying them. They also had told me that I did not have a deductible when in fact I do. I didn't have the emotional energy to argue on the phone so I set up a payment plan. (Also, they wouldn't let me make the appointment without the payment plan.)

On Saturday I went to the pharmacy to pick up the refill. They'd gotten no response from my doctor's office. I sort of freaked out and he said they'd fax them again, but since it was the weekend, no one would respond until Monday. He gave me a three-day emergency supply. Today is my last day.

I called the doctor's office today and was routed to the doctor's voicemail. I happen to know that she only works in that office on Mondays - I don't know what she does or where she is the rest of the week. I left a somewhat panicked voicemail with my number and the number of the pharmacy.

The office called me back and told me that the reason they hadn't refilled my prescription was that I hadn't scheduled a followup appointment. Except that I had, and when I told her this, right away she saw it in her computer. I am furious that they didn't tell me or the pharmacy why it wasn't being refilled. Withdrawal from this medication is not pleasant. Seizures are very rare side effect but have been known to happen. If they still don't contact the pharmacy, what should I do? I'll go to the ER if I have to.

What do I do about the billing and insurance mess? I feel very, very betrayed and angry, and as soon as I get the refill actually in my hands, I will be cancelling my scheduled appointment and finding another psychiatrist. Since I agreed to a payment plan, I might not be able to fight the charges, but is there anything I can do? I am going to get written verification from my next psychiatrist's office that he or she is in-network; is this the right way to go?

posted by desjardins to law & government (30 answers total)

Just to clarify - this is not a scheduled medication, it has no street value or "fun" purpose, and I've been on it for years.
posted by desjardins at 8:38 AM on August 14, 2012

You could consider going to a walk-in clinic and explaining to them about the need for the medication; they might be willing to write you a prescription, especially since it's not a med with street value.

Regarding the insurance issues, depending on the amount, I would consider talking to a lawyer or small claims court.
posted by insectosaurus at 8:41 AM on August 14, 2012

Contact your insurer to see what their opinion is? Also, just thinking of it in terms of a contract, one could say you'd only agreed to pay X you paid X and so they get no more X.
posted by angrycat at 8:44 AM on August 14, 2012 [1 favorite]

Do you have a primary care doctor? My primary care doctor took over monitoring my depression meds when I stopped seeing my psychiatrist. (Also, my GYNECOLOGIST once wrote me an emergency prescription for the same meds, when I realized I had run out and couldn't contact my regular doctor. She warned me she would only do it once though.)
posted by SuperSquirrel at 8:46 AM on August 14, 2012 [4 favorites]

I'd make a consumer complaint to my state's medical board.

This is not just a billing issue. It's a quality of care issue. If the office isn't communicating with you, how are you supposed to know what you need to pay? And if you don't pay, and you can't receive a prescription refill without paying, what are you supposed to do? Last I checked, humans weren't telepathic.

They need to improve this side of their services dramatically.
posted by zizzle at 8:54 AM on August 14, 2012 [13 favorites]

I just had a terrible thought - she's probably only going to write a refill that lasts until my next appointment with her (Monday), and there's no chance I'll be able to make an appointment with another psychiatrist by then. I do not want to see her Monday because it will mean another $150-200 charge. Is my regular doctor going to think it's weird if I tell him I'm firing my shrink and I need him to prescribe this now?
posted by desjardins at 8:54 AM on August 14, 2012

Is my regular doctor going to think it's weird if I tell him I'm firing my shrink and I need him to prescribe this now?

I am betting no, especially if you give an abbreviated rundown of why you're firing the shrink. And I'd also bet that you are not your PCP's first patient to come to him/her with a one-off emergency need for medication that would ordinarily be prescribed by a different doc.

Seconding the complaint to the medical board, and it wouldn't hurt to CC your state's insurance regulatory agency (it may not do any good, but when you send your psych the letter with the "CC: [various agencies]" notation on it, that might help move things in a better direction.
posted by rtha at 8:59 AM on August 14, 2012 [18 favorites]

I agree, go to your regular doctor, explain the situation, get a script (that allows you enough time to find a new psychiatrist) and start looking for a psychiatrist with some ethics.
posted by HuronBob at 9:02 AM on August 14, 2012 [2 favorites]

I'm going to be the odd guy out here, but I don't think you have much of a case for complaint or small claims court.

There are many, many drugs that require being seen before writing a prescription - even if you've been on it for years.

Unfortunately, it's not the doctor's job to make sure that you don't run out of meds. You should have contacted them sooner.

It's also not your doctor's job to tell you that she is not an in-network provider. You should have been receiving statements that documented the coverage by both your insurance company AND the doctor's office. Claiming that you didn't know will not work in a court.

Yes, your doctor made an oversight by not granting the short-term prescription without seeing the appointment "in the books," but again, if you had booked the appointment in advance, this would not be an issue.

I sympathize with your situation. It sucks to run out of meds. The ensuing panic is never fun.
posted by frizz at 9:05 AM on August 14, 2012 [3 favorites]

When I've run out of meds and couldn't get in to see the psychiatrist in time, I have both 1) asked the pharmacy to advance me some pills, and 2) asked another doctor to prescribe the meds for me, given the circumstances. Both came through for me. Pharmacists understand that it's *not good* to suddenly abort meds like this, so I wonder if they wouldn't mind advancing you a few more days. And other doctors understand this as well, so I very highly doubt your other doctor will have a problem writing you a prescription for, say, a month. Caveat: I am in Canada and this kind of thing may work differently here. But I doubt it.
posted by kitcat at 9:06 AM on August 14, 2012

meh. so maybe you don't have a legal case against this doctor or office, but they're clearly giving you "who gives a shit" care. instead of blaming myself, i'd get a new shrink too. the immediate situation? yeah, it's easier said than done, but try not to get too wound up, you'll definitely find a doc to write you something to tide you over. at the worst, you can always go to the half-ass doctor one more time for cash, then not be in a rush to find a new doc. options, options.
posted by facetious at 9:10 AM on August 14, 2012 [1 favorite]

Is my regular doctor going to think it's weird if I tell him I'm firing my shrink and I need him to prescribe this now?

That's highly unlikely. Call your dr's office to explain the situation, many PCP's have done this before. In fact, I'm remembering that a friend of mine went through something similar and went to her regular dr for a prescription to tide her over.

Make finding a new dr a priority. I'm not sure what the office hopes to gain by acting in this manner - maybe they feel they will get more money from patients than from insurance, since insurance pay at negotiated rates. Or maybe they're just that incompetent. But it's unacceptable for many reasons.

As for your insurance, that's a little trickier. You say that you checked in January and she was in network - have your insurance tell you when that changed. Have you been receiving an Explanation of Benefits statement? That would have shown you that something was wrong. Explain to them that you did your part by checking her network status when you came onto the insurance, and ask to speak to someone who can help you out with this and perhaps authorize payments for the out of network visits. They might suggest that the doctor's office start that process. It's a longshot, but it's worth it.

It's also not your doctor's job to tell you that she is not an in-network provider.

It's not the doctor's job, but it is the staff's responsibility to inform a patient of that, even if it's when they are checking in for their appointment. If nothing else, not doing so puts the doctor's reimbursement at risk - especially if they were not asking for payment up-front all this time.
posted by DrGirlfriend at 9:12 AM on August 14, 2012 [1 favorite]

At that time, I had confirmed that she was listed on their website as being in network. I gave the doctor's office my new insurance information, and since January they've been taking my copays and billing the insurance company. In seven months, no one has told me that she was out of network (her certification or whatever was not renewed) or that the insurance company was not paying them. They also had told me that I did not have a deductible when in fact I do.

Who is they? The staff at your doctor's office? Did you ever confirm this with your insurance company? If your insurance company had your doctor listed as in-network and they denied coverage, I would file an appeal. You should have been receiving explanations of benefits or statements from the insurance company all along--contact your insurance company to get copies of the claims that were submitted, and get copies of all the bills from your doctor that she submitted.

It's really strange that you haven't been receiving any documentation from the insurance company about this for seven months--they would be my first call. After calling your GP for a refill on your medication.
posted by inertia at 9:19 AM on August 14, 2012 [2 favorites]

1. Call your PCP, he/she will be happy to write your new Rx. You'll get an emergency month, and then make an appointment for follow up. Failing that, Doc in a Box, or if no other option, ER. Don't freak. You'll get it.

2. I've been there with the flaky office. You're not in Atlanta are you?

3. Once you're back on track, and have a new doctor lined up. Calm and collected, write a factual email, copying your old insurance, your new insurance and your doctor's billing department and you doctor.

I'd make the following points:

1. I should have been informed by the office staff that the doctor was no longer in-network.

2. I should have been informed by the insurance company, via EOB, that the invoices weren't being covered.

3. I should have been informed IN A TIMELY MANNER by the doctor's office staff that the bill was in arrears so that I could have made a decision NOT to continue with this doctor, considering the insurance issues.

4. Based upon the incompetance of the doctor's staff, I will not be paying any additional fees, as if I had been informed, I would not have continued to use this doctor.

5. That the issue with the prescription was unprofessional and dangerous and that as a separate issue, I will follow up with a complaint to the appropriate boards.

Doctors are notoriously terrible at the business end of their practices. (Sorry, sweeping generalization based upon years of experience). Gawdawful. Watch Boiler Room, they get taken on a regular basis. Hoo! Have I got stories.

Doctors need to be as involved in the day-to-day running of the practice as much as they need to be up to date on the latest treatments. This can be a wake up call to your doctor that things need to change.

Let him/her sue you.

Start a file and get your ducks in a row.
posted by Ruthless Bunny at 9:39 AM on August 14, 2012 [16 favorites]

frizz: "It's also not your doctor's job to tell you that she is not an in-network provider. "

Actually, it is the provider's job to communicate this --especially as laid out in the post. If anyone in your doctor's office confirmed that they were in network and they weren't, they were fraudulent and your insurer would really like to hear about that and could be an ally in the situation. If the insurer's website was wrong as of a certain date, then it may become an issue where the insurer is liable. (speaking from experience on the latter)
posted by MCMikeNamara at 9:41 AM on August 14, 2012 [5 favorites]

I can assure you (as someone who gets calls for emergency prescriptions for drugs that I was not the primary) this is not a huge deal. Your MD will call a month or two in and ask if you'll need a follow up appointment of if you're going to have a new psyc by the time your month runs out. This is really really normal, it happens several times a week.

Also, please document all the things that happened today, while its fresh in your mind. Hopefully this will all resolve itself after a clear letter to the psyc, but just in case you want to have a good record.
posted by Nickel Pickle at 10:30 AM on August 14, 2012

Ruthless Bunny's plan looks great.

I think it is especially important for you to realize that you have two separate problems here:

1.) Medication refills. You need a full refill ASAP. Whether that means calling your GP to try to get an appointment, or sucking up the $200 to go back to your shrink one more time, you need to do that.

2.) Billing. Once you have the refill issue sorted out, gather up all the paperwork that you can find since January (you should have co-pay receipts, Explanation of Benefts, etc), and figure out what exactly was communicated to you when. Then go on the offensive with the shrinks office/insurance company (in a professional, calm, and organized manner).

Good luck!
posted by sparklemotion at 10:45 AM on August 14, 2012

Is my regular doctor going to think it's weird if I tell him I'm firing my shrink and I need him to prescribe this now?

I don't think so, especially if you explain the situation. Stuff like this happens a lot, and I think PCPs are pretty understanding about it. For example, at one point I saw an allergist and a regular internal medicine doctor. I carry an Epi-pen, which needs to be replaced annually (and is, uh, kind of important). Sometimes, the latter would write me a refill, and sometimes the former. It was never a big deal, and just came down to which doctor I could get an appointment with first. Neither of them ever questioned me. I'd just call your PCP and explain what's going on and what you need. Since you say the drug in question isn't scheduled or anything, I doubt you'll have trouble.

I hope you can get this all straightened out, refill your prescription, and find a new psych, stat.
posted by easy, lucky, free at 11:03 AM on August 14, 2012 [1 favorite]

There's a documentary floating around right now called The Waiting Room, which is about an Oakland emergency room. One of the striking sequences shows that when people -- who are often low-income and sometimes even homeless -- come into the ER for various things, the staff often inventories their meds and sees what's running low and takes it as an opportunity to give them refills, or refill prescriptions, for everything. Blood pressure meds, diabetes meds, heart meds, not necessarily having anything to do with why they came in. It's a chance for them to see a doctor, so the doctor refills the medications they need. I don't remember seeing it specifically, but they may well do the same with the kinds of meds the patient might otherwise get from a psychiatrist. And that's in an emergency department.

I really do think other docs do this kind of thing all the time and will not be fazed. They understand. Try your GP, for sure. (In fact, most people I can think of in my life who are on antidepressants, for instance, get them through their PCP, not a psychiatrist.)
posted by Linda_Holmes at 11:20 AM on August 14, 2012 [1 favorite]

My regular doctor just wrote me a year prescription for my medication, because I called and left a message that I was done with my weird psychiatrist. It was no big thing. He didn't think it was weird at all. As my doctor, he's aware that I have a psychiatric history and wants to help me.
posted by Coatlicue at 11:22 AM on August 14, 2012 [1 favorite]

I'm pretty sure taking your copays as if they were still in network qualifies as insurance fraud, just from a different direction, so call your insurance company and tell them (and ask them who in the regulatory world you could call). Frankly, that they're hitting you with billing like this, coupled with their inexplicable falling out of the network, tells me maybe something else hinky is going on with the office.
posted by rhizome at 11:53 AM on August 14, 2012 [1 favorite]

Lots of good advice upthread. I would add one step, however. Before getting your insurance company involved, I would explain the situation to the doctor's office/business manager. It may be a case of front office staff not handling the situation correctly and the office manager would appreciate knowing that and may reduce your bill or offer some sort of compromise. If they don't offer an agreeable solution, you can always escalate to the insurance company, etc.
posted by SweetTeaAndABiscuit at 11:56 AM on August 14, 2012 [3 favorites]

What changed at the doctor's office? They've been carrying along without notifying you about this bill for 7 months, and now suddenly it's a big deal? That's surprising.

Has there been a staffing change there, maybe? If someone who was not doing their job (ie, not telling you about the doctor going out of network, not paying attention to overdue accounts, etc.) has just been replaced by someone who IS doing their job, that could explain the sudden attention to your bill. If I'm right about this, it's possible that the new, competent person will be willing/able to help you out here, whether by reducing your bill or by working with the insurance company to fix the error (which, after all, seems to have been shared, since neither doctor nor insurer notified you of these bills).

If this is the case, the best way to work with your doctor's office staff is to use a firm but civil attitude. Obviously I'm speculating here about what could be going on on the office side--but if someone identifies themself as new to the staff, for example, that would be a good person to treat politely if possible. (Still firm, though, you have definitely been treated badly and deserve some major reparative action on the office's part!) I'm basing this advice on my experience working in offices with the kind of situations going on where accounts or whatever are allowed to slide for months and then suddenly are an issue when a competent person is hired. It sounds to me like things could be about to improve there, and if that's the case, hopefully they will make things right with you.
posted by snorkmaiden at 12:21 PM on August 14, 2012

I'm sorry that you are in this position. It's disappointing that the doctor and front office staff have communicated so poorly with each other about this. It led to nobody communicating well with you.

However. It is ultimately the patients responsibility to know what their coverage is. You presumably have not received a single Explanation of Benefits (also known as eob) from your insurance company, which would have been a clue that they weren't paying this doctor.

As tempting as it is to want to hold the doctor accountable for this, you likely signed a raft of paperwork with both the doctor and your insurer that you are responsible for anything the insurer doesn't pay. Vigilance is key when dealing with insurers, because they will look for any reason not to pay.

The bright side of this is that many will reimburse you for part of your out of network costs. Revisit your contract and ask for the verification information recovered by your psych office. Hopefully they received it via fax.

Additionally, I understand the inclination to be furious with the doctor over this. After all, he front office represents the doctor. They are an extension of the doctor. But keep in mind, they are not the doctor. Tell the doctor, in person, what went wrong. This could just mean writing what you posted above in a letter and saying, you need to know about this, but I'm not ready to discuss it with you. No doctor has the time to babysit the front office. They do not watch them schedule appointments or handle phone calls. Patients are reluctant to complain about the front office, for a Number of reasons. If nobody complains, the problems continue. While its not your job to save other patients the hassle of this experience, if you have a positive therapeutic relationship with this doctor, it very likely can be salvaged.
posted by tulip-socks at 12:40 PM on August 14, 2012 [2 favorites]

Your GP should be able to advise you about your prescription and help with your immediate refill needs or until you find a new psychiatrist.

As for dealing with your current psychiatrist I would recommend calling or contacting the state medical board for your state as well as looking up contact info for the state medical association. Just Google YourState Medical Association and YourState Medical Board and the websites will likely have patient advocacy information. They should also be able to direct you as to the best way to make a complaint about the psychiatrist.
posted by forkisbetter at 1:05 PM on August 14, 2012

Tell your MD that you are close to being noncompliant with medication and that you do not wish this to happen. Many psychotropic drugs work only when there's a sustained level of medication in the bloodstream, and going off schedule or running out can set back treatment until optimal levels are reachieved. (Pretty sure you know this, desjardins, but it's a good way to phrase the request to your MD. Noncompliance is a big deal, especially when the patient doesn't want to be.)
posted by catlet at 3:03 PM on August 14, 2012

nthing going to your PCP.

Unfortunately I've found that January is the time that insurance companies do a lot of switcharoos, so it is possible that (if you checked the website in, say, late December?, to find a provider) that they didn't update their provider list. to be uber-safe i'd get written confirmation from the insurance company too.
posted by NikitaNikita at 3:06 PM on August 14, 2012

Your PCP should be able to help you, definitely. Walk-in clinics likely will not -- they don't do psychiatric drugs as a rule, because they don't really have a means of seeing you on a follow-up basis. (At least around here they won't -- I tried that route when my former psychiatrist abruptly dropped me a year or so ago. Running out of meds did suck, and going to ER sucked, too. Try your PCP first.)
posted by sarcasticah at 4:33 PM on August 14, 2012

The doctor did call in a four week supply, so if I can find another psychiatrist by then, I will, otherwise I'll go to my PCP.
posted by desjardins at 8:50 PM on August 14, 2012

Any business has a responsibility to bill you accurately and promptly. Call the business office/bookkeeper, and ask why you have not received accurate billing information. This is a huge expense, and I don't think you should be on the hook for it. Maybe a month or 2, but not 8 months.

You have to find a new provider. Ask your insurance company and your primary care provider to help you find a new psychiatrist, as well as asking your insurance company about the appropriateness of your doctor's billing practices.

You might be able to go to an urgent care provider and get a short term or regular prescription.

What a messy, stressful situation; Good luck.
posted by theora55 at 9:09 PM on August 14, 2012