Can medical providers commit extortion?

December 17, 2007 11:14 AM

My regular doctor quit the medical group and I was assigned to a new doctor. Its the second time in three years. The new doctor wouldn't renew any of my prescriptions without seeing me first. During the office visit, we met, chit-chat a bit, and I get the refills. Now I get a bill for $198. (adjusted to $142 by my major medical coverage) The medical group is the having trouble retaining staff. Shouldn't this visit be on their dime?

I know this is probably a hopeless case and I should have made issue of it BEFORE the appointment. I questioned it briefly but caved in without a fight. I'm going to send a letter per the dispute instructions and ask for the bill to be eliminated or reduced.

I pay medical expenses out of pocket with HSA backed up by major medical coverage. I understood the concept of HSA is to get the individual more involved with controlling costs. The providers make it impossible to do so.

I'm also going to send a letter to my congressman and propose a law that requires fair and open billing by medical providers.

I'm looking for any suggestions or ideas on how to proceed. Or should I just shut up and pay?

posted by jorlando to health & fitness (20 comments total)

Is your coverage a PPO (open network) or POS? Something similar almost happened to me last week: I went to my Doctor's Office to discover my doctor was no longer there. My coverage only covered certain doctors (a "POS" they call it - ha!), regardless that it was the same office. Luckily they told me beforehand; I had to call my insurance to see if the new one was was covered (she was but only at an address in New Jersey, not in Brooklyn). I irately went elsewhere.
posted by yeti at 11:28 AM on December 17, 2007

In a similar situation once, I simply didn't pay the bill. It went to collections and probably damaged my credit rating, but whatever.

Making a nuisance of yourself on the phone will often get it reduced, but it seems hardly worth the effort.

The complexity seems to be intentional in order to create a situation where customers end up legally obligated to pay before knowing how much. This is also how the phone companies make their money...
posted by teki at 11:29 AM on December 17, 2007

I'm neither a doctor nor a lawyer, but I think the new doctor did have a responsibility to meet you and make sure the prescriptions were appropriate before renewing them. However, I would still cotact the clinic and suggest that this should be on their dime. I would start with the billing department and ask for a manager and see how far you can get. Check how soon you need to send the letter - my instinct is that you would do better with personal contact over the phone but you don't want to lose your right to protest. Just make sure you stay calm, be as sympathetic as you can while emphazing that you are just asking for what is fair and reasonable under the circumstances.
posted by metahawk at 11:35 AM on December 17, 2007

Is twice in three years unreasonably frequent for an MD to check on your progress with a prescription? Even if your doc hadn't changed? I don't know, just asking -- I've never had an "ongoing" prescription for anything chronic.
posted by stupidsexyFlanders at 12:18 PM on December 17, 2007

i am not a doctor, but i would imagine that unless you are on some serious drugs or have complicated health problems, a doctor could have determined what was appropriate just by reviewing your charts.

my guess is that they "required" you to have the appointment so they could bill you. the turnover is worrisome for me. it might be time to find a new doctor's office. can you just follow your old doctor to his/her new practice?
posted by thinkingwoman at 12:18 PM on December 17, 2007

A lot of times doctors "in practice" together are a lot more like freelancers sharing office space and an admin. They frequently don't take the same insurances, etc. So the new doc may not have any financial connection to the old doc. You are just another new patient to him.
posted by COD at 12:35 PM on December 17, 2007

Seconding metahawk. Renewing the scrip that your previous doctor gave you transfers responsibility for the treatment onto doctor #2. Malpractice insurance being what it is in the Pacific Northwest they want to see you before renewing your prescription.

You'll find very few doctors willing to renew your scrips without previously meeting you, though the point you make is a good one. If you saw doctor #1 in the last 3-6 months prior to having to come in to see doctor #2, you have a VERY good point and they should probably either not bill you or bill you significantly less.
posted by arnicae at 12:37 PM on December 17, 2007

It's strange that the doctor, by wanting to meet you and evaluate you personally, has now incurred your wrath. Realize that, when you go to a professional and expect them to provide a service, they are entitled to be paid for the service. Keep in mind that, if you never met him, and he renewed your prescriptions, and then the drugs harmed you in some way, a lawyer would probably argue that it was negligent of him not to require to meet you before renewing the prescriptions. The doctor is in a no-win situation.

I'm also going to send a letter to my congressman and propose a law that requires fair and open billing by medical providers.

That is ridiculous. Don't be the patient from hell.
posted by jayder at 1:05 PM on December 17, 2007 [2 favorites]

jayder's comment harks back to the era when there was a profession known as medicine. now it's a business called healthcare, and you may be sure that the old and new doctors, the clinic and the insurance company are all looking after themselves. don't you be the slowest fish in the water. look at it in the same light as buying new tires. you say this is the second time in three years. if you purchased four new tires and four months later, the tread had all worn off, you'd go back to the tire shop and say yo, dude, the bald tires, we need to adjust this account to recover my prorated value for the lifetime wear i expected but did not receive? so, what exactly is the expected lifetime of a meeting to determine if your scrips are ok, i have no idea, but a starting point for the adjustment you seek should be based on the expected lifetime minus the time elapsed since the last meeting.
posted by bruce at 1:50 PM on December 17, 2007

It is good medical practice to personally evaluate a patient prior to writing or renewing a prescription. However, the fact that this was required seems to have been the office's fault. Talk to them. Perhaps they will be willing to waive the deductible.
posted by caddis at 1:56 PM on December 17, 2007

The meds you are taking have a huge role in whether there's any room for discussion. And consider yourself lucky to have a circumspect and cautious physician.
posted by docpops at 2:04 PM on December 17, 2007 [1 favorite]

Seconding the 'don't overreact' sentiment. The new doctor was right to meet you before prescribing medicines. The only potential mistake you've made so far is not demanding (which is a strong word...you usually just need to ask nicely) an estimate of what the bill will be BEFORE you set the appointment. I know prices vary by location, but $200 sounds kind of pricey for just a chit-chat consultation. At any rate, call the billing office and make a reasonable offer (maybe $75) and work from there. You could not pay the bill, as teki suggests, but just remember the next time you need those prescriptions renewed they will first require you to pay your old bill plus late charges.

Also, don't send a letter to your congressman. From the way you describe the situation, I don't see anything morally, ethically, or legally wrong with anything that has happened. Creating new laws will just mean you (and the rest of us) will have to pay even more money the next time we go see the doctor.
posted by wabashbdw at 2:06 PM on December 17, 2007

How long had it been since you'd seen any doctor at the practice with regard to these particular prescriptions? Like arnicae said, if you'd seen your previous doctor recently, that's one thing, but if your previous doctor(s) had just been rubber-stamping your prescriptions for a couple of years, it would certainly make sense for a new doctor to decide that it was time for a check-in, even though you may feel nothing has changed (and we don't know how complex your condition is). It does seem to me you're going to an expensive practice if they bill $200 for a basic chat, and you may have some wiggle room there if you approach it politely, but the time since your last visit does make a big difference in deciding whether the new doctor was 1) being properly cautious or 2) somehow trying to gouge you.
posted by mediareport at 3:13 PM on December 17, 2007

This is one reason why HSAs make me cringe. The practical reality of "shifting responsibility" to health care "consumers" is the consumer seeing much fatter bills (once swallowed by a 3rd party) when their HSA is attached to a high-deductible insurance plan, the patient developing an antagonistic relationship with his health care providers, and the patient ultimately forgoing preventative care in the future, only to lead later to a medical catastrophe that causes them morbidity and costs us even more money. Since you brought up politics, if you're going to write your congressman, you might consider using that energy to lobby for a health care system that might actually make sense, and voting as such.

I can't speak to what level they may have billed your visit and how much it "ought" to cost, though calling the billing department to at least get some clarity isn't a bad idea and may save you some cash. If you weren't physically examined at that appointment as you suggest, it's very important to let that be known as it may have a direct effect on the level of appropriate billing and would potentially make billing for a new patient visit unrealistic. Unfortunately, making sense of medical billing and levels of service is near impossible so I can't really elaborate on it any more than that.

By the way, bruce's analogy is a terrible one. Just because your new doctor happens to work at the same physical space as your old one doesn't mean you should expect him/her to signoff on any old prescriptions you may already have from someone else, or be responsible for any medical decision-making that went on in his absence. They likely don't know you from Adam and certainly shouldn't be expected to renew prescriptions for a stranger they've never met.
posted by drpynchon at 3:43 PM on December 17, 2007 [1 favorite]

I'd be surprised if it was legal/ethical for the new doctor to write prescriptions for a patient s/he's never seen. My own GP won't renew prescriptions I got from a walk in clinic while she was unavailable unless she sees me first. Of course, I don't have to pay for my doctor's visits which makes that slightly less annoying.
posted by jacquilynne at 4:07 PM on December 17, 2007

Thanks to all for taking the time to answer my post. Its good to get different points of view on things like this. I'll concede that the new physician couldn't issue refills without becoming familiar with my case. Its a good point. I think the charge is arbitrary and excessive however and will follow their normal dispute process and ask to have it reduced.

I did call the billing office before making the post. They had no clue. I asked the basic charge for an office visit and they couldn't answer - just that it varies depending on what the Dr. does and the bill originates with the Dr.

I'll be more proactive in the future and ask questions beforehand. We'll see what happens.

Also, jayder, I'm polite and diplomatic. What is it that makes me a patient from hell?

jo
posted by jorlando at 5:58 PM on December 17, 2007

I just meant that writing a letter to your congressperson trying to get new legislation passed, over a couple hundred bucks you wish you didn't have to pay, would make you the patient from hell.
posted by jayder at 8:10 PM on December 17, 2007

jayder's wrong. Screaming and writing letters to the *doctor* would make you the patient from hell, but writing your congresscritter would not.
posted by mediareport at 10:25 PM on December 17, 2007

It's normal for docs to want to check in for an annual prescription renewal - and not a bad idea, either. A lot could have changed. This is twice in 3 years? Yes, the practice has a retention problem, but a periodic in-person check about prescriptions is not part of the problem.

You might ask to be billed at a lower rate, but not be billed at all? I don't think that will get very far.
posted by caitlinb at 12:19 PM on December 18, 2007

Oh, and I worked in a health insurance company for 3 years and administered billing in a hospital setting for 5 years. It's rarely the providers that make it impossible to control costs. It's more often the horse-trading the big corporations are doing that make it impossible for providers to afford nurses.

Billing levels for different levels of visits are fairly regimented. It sounds like you were billed as a new patient for that doctor, but didn't receive new-patient level service. You might ask to ask to be billed as a return or follow-up patient, and in my clinics that process would have started most efficiently with the nurse or with an in-clinic case manager (as in the specialty clinics where I worked).
posted by caitlinb at 12:26 PM on December 18, 2007