My doctor has inflated my bill.

May 16, 2006 4:28 AM

How do I fight an inflated doctor bill?

Short version: My doctor presented me with a signed list of charges for a diagnostic visit, and later I received a bill that was $142 higher than what was presented at the time. I have their photocopy of the complete bill form. How do I fight this?

Long version: I've had several phone conversations with the doctor's office and their billing office. All they've done is restate the bill at the inflated level. It's for a set of X-rays that they say was mistakenly omitted from the charge sheet they presented to me. This is false; the X-rays are documented on the charge sheet. The relevant portion, pictured here, records that both knees were X-rayed, and the accompanying charge.

Weeks/months after the fact, after the insurance situation shook out leaving the bill entirely my responsibility (as I expected), the bill was mailed to my home, but now it was $142 higher than the ~$500 total indicated on the charge sheet, with no explanation other than "Pay up, or it rises by 1.5% per month."

In between diagnosis and billing, I got a second opinion from another doctor, at which I presented the X-rays the first doctor is charging me for. The second doctor's immediate reaction was visible frustration that the X-rays had been botched and were "useless" for diagnosing the condition in question. Doctor #2 ordered new X-rays, which led a diagnosis directly contradicting that of doctor #1.

And just adding to the fun is that doctor #1 used my case as an example with an intern, thereby teaching his poor technique to another doctor.

Given all this, I'm disinclined to passively accept more ill treatment in the form of bogus billing from this doctor. Justice would be getting no charge at all for the portion relating to the botched diagnosis, plus confirmation that he had admitted and documented the error with the intern. I'll settle for them sticking to the bill they signed and presented to me instead of pulling new charges out of thin air and expecting me to just suck it up. How do I fight this?

posted by NortonDC to law & government (14 comments total)

Malpractice suit?
posted by antifuse at 4:40 AM on May 16, 2006

I'm trying to understand the accounting. Did the initial list of charges omit the xrays from the total costs? If so that would have been fixed in the actual bill. Does the bill contain a list of work done? If so it almost sounds like it would list 4 knee x-rays if you are being billed twice for them, or that the x-rays are twice as expensive as you were led to believe.

You should be able to demand an invoice of the work with costs per item of work. If your in the US, a word with the better business bureau would help if the office doesn't want to provide that to you. I also don't think it would hurt to see if the state licensing board has had any complaints about the doctor. Often this can be done over the internet without having to contact anyone.

Not sure about the botched x-rays. I'm sure others will have a better feel for that aspect.
posted by jwells at 5:00 AM on May 16, 2006

Well, I would say this qualifies for small claims. Just do it and get it over with. The moment he seems the small claims affidavit at his door he'll run away and give you the original bill price (or even give you the work for free!)

His time is BIG money. Just the 2 or 3 hours spent at the small claims office will cost a HELL of a lot more than $142. And he will need to show up (or a lawyer / paralegal, which again, will charge that kind of money).

Don't forget to tell him you want the court charges taken out of the bill too!
posted by shepd at 5:20 AM on May 16, 2006

I had a similar situation where I was billed for services rendered, and I didn't even remember going to that doctor. Thinking it could have been a lab, I wrote asking for an explanation and kept on getting the same bill. The phone number was constantly busy.

I sent a certified letter stating that if I didn't get a complete itemized bill and explanation of the charges in 30 days then I will consider the matter closed and that I would owe nothing. Never heard from them again.

Your situation is somewhat different, but I think people like this count on most people meekly sighing and paying up. Small claims as shepd mentioned or even something like a certified letter stating you dispute the bill often works wonders.
posted by xetere at 5:38 AM on May 16, 2006

Don't pay the bill. As xetere said, most people wuss out and pay. I wouldn't. I had the same problem for a more modest amount, about $20, and didn't pay.

Stop the phone calls. You need written proof should this problem continue. Write a letter laying out the whole problem, telling them that you have no intention of paying & send a copy of the original bill. Send it certified mail with a return receipt and a signature required. If there is a separate billing office, send it to both the doctor's office and the billing office. In my case, the letter shut them up.

I also don't believe that medical bills can be used against you as far as a credit report goes.

IMHO xrays cost a doctor's office peanuts. They're just screwing you.
posted by bim at 5:57 AM on May 16, 2006

Malpractice suit?

This does not qualify for malpractice. The simplistic mnemonic we're taught (that I'm sure lawyers would laugh at):

The 4 D's. The doctor must have a Duty to the patient, there must be a Dereliction of that Duty, that that Dereliction must have Directly Damaged the patient's health.
posted by gramcracker at 7:12 AM on May 16, 2006

Usually, x-ray charges include a fee for interpretation of x-rays, a job performed by radiologists (not x-ray technicians, who just take the pictures). In this case, it sounds like the radiologist was a wanker that didn't pay attention, assuming it is correct that the x-rays were no good for the purpose intended.

I sympathize. We just got a bill from someone saying we are way past-due on a medical bill. It's an ancillary charge relating to trauma care, and the first time they've bothered to send the bill at all.
posted by Goofyy at 7:31 AM on May 16, 2006

NortonDC, you may recall recent stories to the effect that some hospitals have been charging uninsured patients higher fees than insured for identical treatment. In a number of cases the higher fee was a multiple of the lower. The (hospitals') explanation was that the insurance companies had used their greater market clout with the hospitals to negotitate lower fees.

Maybe when it turned out your X-rays weren't covered, they were 'automatically' billed at a higher rate. I wouldn't be surprised if you could get some relief by threatening to make that an issue.
posted by jamjam at 8:17 AM on May 16, 2006

We recently went around and around with a provider over excessive charges. It looked as if they were double-billing for a procedure they performed on our son. Luckily, the procedure was performed back when we had coverage, so we had the insurer going to bat for us. Eventually, the provider dropped the additional charges completely. But, for awhile there, we were getting regular notices that the charges were overdue and would soon be sent to collection.
It was one of the few times I was actually happy to talk with my insurer.
posted by Thorzdad at 8:38 AM on May 16, 2006

Like gramcracker, I don't see malpractice as the appropriate response to the billing problem.

Small claims court: how would that work? What's my claim against them? I think it's that I'm disputing their claim, not that I'm trying to place a claim on them.

So far certified letter, etc., sounds best, but I'm not optimistic about that.

jwells, they billed me for the set of knee X-rays that they explicitly stated included both knees on the original list of charges (shown in the link above), but when the new bill arrived they showed two charges instead of the collective charge for both knees, with each new charge matching what they quoted for the entire set in the original charge listing.
posted by NortonDC at 10:06 AM on May 16, 2006

Small claims court: how would that work? What's my claim against them? I think it's that I'm disputing their claim, not that I'm trying to place a claim on them.

You'd pay the bill. Then you'd send a letter to the doctor asking for a refund. Something along the lines of:

To whom it may concern,
On such and such a date, I received medical treatment from Doctor X. On xxx, I received a bill from Dr X claiming the amount due for the treatment was $XXX. I was unaware of the falsity of this claim and believed it to be true. On xxx, I sent a check for $XXX to Doctor X. Doctor X deposited this check on x/y/z. On q/x/y, I reviewed a previous bill from Dr X and discovered that the amount I had owed for the treatment, as defined by the previous bill, was $YYY. Had I known the price of the treatment was $YYY, I would not have paid the amount of $XXX. I demand a refund for the amount of $XXX-$YYY, which is the difference between the amount I paid and the amount I owed. If you do not send a check for the amount of $XXX-$YYY to the following address within 7 days of this letter, I will file a claim against Dr. X.

sincerely,
HHH
posted by malp at 11:01 AM on May 16, 2006

I don't think I'm going to perjure myself for $142.
posted by NortonDC at 2:20 PM on May 16, 2006

NortonDC, beats me what statute / law would cover it in your area, but most places do have laws against changing bills like this (or so I recall). It's probably in the UCC in the US... or perhaps not. Beats me! In Canada it's pretty easy, you just check "Breach of Contract" and you get to, in normal english if you prefer (assuming you can't find the appropriate law) explain your case in the small affidavit section below. There's two pages. First one is the address/name of you and the person being sued. The next is the details of your claim (checkbox, amount, affidavit, explanation). You can attach extra stuff (like evidence [such as bills, etc]). That's pretty much it, here. They're expecting, for most disputes like this, 3 or 4 pages, maybe 5 tops.

If you do sue, at least you will have shown your interest in resolving the matter and, assuming you explain that you *want* to pay the original amount in your claim, your willingness not to be a deadbeat. Armed with that, I don't see how a reasonable person would charge you any interest on the amount if you somehow lose.

Yes, that way is less professional, but small claims doesn't really expect (although they probably appreciate) someone being very professional. They're dealing with "petty" disputes between regular joes, not lawyers (most lawyers will charge FAR more than what small claims would recover).

Or yes, you can do it malp's way (which is also, AFAIK, pretty standard) -- although malp's way may mean you are out the money a period of time. But, if you do get it back, there's no question you wanted to pay the bill at all.
posted by shepd at 3:12 PM on May 16, 2006

To add to the suggestions above, here are two possible ways to approach disputing the inflated charge:

1- it looks like they messed up their quoted charge on the first bill. A 3-view x-ray of the knee (CPT 73562) typically runs about $143--and that's for one side. Even though they wrote down L&R, it seems they forgot to double the charge on that first bill. They didn't omit a set of x-rays on the charge sheet like they're saying (since the L & R is noted); they quoted the wrong price for the bilateral knee x-rays. So one tactic would be to demand you pay the price initially quoted you, even if it was wrong--the mistake was their fault. You know, along the lines of if a restaurant prices an item wrong on the menu, they have to charge you that quoted price. I don't know if this will hold water, though it is a shoddy mistake to make on top of taking useless x-rays.

2- another tactic would be to request a discount as an uninsured patient. If your insurance hadn't fell through, the amount they would have been paid by the insurance would have been far less than the total bill (insurance takes "adjustments," but individual payers don't get that discount, which is bullshit). Tell them that the bill in total is unpayable, but that you will pay the bill in full if 20-40% of the total is taken off (the whole bill, not just the knee x-rays). Not an uncommon way to lower a large medical bill when you don't have insurance.

The fact that the x-rays were botched is frustrating, but how you'd use that to dispute the charge inflation is beyond me. Good luck! I've had a kinda similar problem with a procedure that insurance didn't cover, and it was iresome to deal with. fwiw, I got a chunk of the bill knocked off by using the second technique.
posted by neda at 8:15 PM on May 16, 2006