How to Force a Doctor to Fix a Billing Mistake
June 7, 2015 12:03 PM   Subscribe

Two months ago I went to a new doctor for my yearly physical at the recommendation of a friend. I've talked with my insurance provider before and they said that an annual physical is covered and should cost me approximately nothing. So I was surprised when I later got a bill for several hundred dollars. The root of the problem seems to be that the doctor classified everything as diagnostic rather than preventative. My insurance has said they can't do anything unless he contacts them and changes the classification. I have called and emailed the doctor's office multiple times to clear up the issue, but they have done nothing and I am still getting bill reminders for several hundred dollars. What additional action can I take, legal or otherwise, to force this doctor to fix his mistake?
posted by C'est la D.C. to Work & Money (10 answers total) 6 users marked this as a favorite
Have you specifically tried to speak to the person who handles billing in your doctor's office? Are they refusing to do this or saying they will and not following through? If they are not following through, you might try stopping by the office in person.
posted by needs more cowbell at 12:18 PM on June 7, 2015

Response by poster: Each time I speak with to billing, they say they have to speak to the doctor and will get back to me which cuts me off from pressing the issue further at that time. And every time I speak to billing, I get someone different.
posted by C'est la D.C. at 12:23 PM on June 7, 2015

Step 1: Write a letter to the doctor's office on formal letterhead and send it registered mail. Please ask them to immediately correct this mistake. CC: the insurance company. Be sure to structure it like any other billing dispute letter. Clear details will ensure that there is a valid way to follow-up with legal action in the future.

If the situation isn't resolved in a timely fashion,
Step 2: Submit a complaint to the Better Business Bureau. (Be sure to mail a copy of the complaint to the doctor's office, and cc: your insurance company - both registered mail). Most doctor's offices respond to BBB complaints.

And if the situation is still unresolved after complaining to the BBB,
Step 3: Submit a complaint to the State Medical Board. (Be sure to send a copy of the complaint to the doctor's office/billing office, again cc: your insurance company - both registered mail)

Then last, but not least, hire an attorney to assist. Contact a law firm and explain the problem. You can do much of this over the phone these days. They will write the doctor's office, cc: the insurance company and expect a reply. In my experience, companies drop everything until they clear up such a dispute. It really is remarkable how the threat of legal action makes people reply quickly. It may cost a little money, but would likely resolve the issue.

Best of luck!
posted by apennington at 12:47 PM on June 7, 2015 [8 favorites]

Getting this fixed will likely require finding someone who will take ownership of this issue. Some tactics you could take:
Try asking for the billing supervisor. This may allow you to get to a consistent person to work with.
Contact the office (not the billing office) and ask to talk to the practice manager (or office manager). They may be able to get to the physician easier than the billing folks do.
If the practice is part of a larger organization (and most of them are), try contacting the corporate HQ.

When you contact these non-billing people, frame your request as a complaint about the responsiveness of the billing department and/or physician. If you describe it as a billing problem, people will want to send you right back to billing.

Also, that doctor is a dumbass. The preventive vs diagnostic thing is an issue for a lot of people under a lot of insurance plans. He or she should know how his or her coding affects people's insurance coverage. And several hundred dollars is A LOT for an office visit without any procedures or imaging.
posted by jeoc at 12:52 PM on June 7, 2015 [4 favorites]

I would drive there in person and ask to speak to the person who manages the practice. Make it impossible for them to ignore you. This is something that is easily done and that they should be accustomed to dealing with.
posted by something something at 1:02 PM on June 7, 2015 [14 favorites]

When you went to the visit, did you say you had any sort of issues? Or did you say that you just wanted him to do a yearly physical and everything was great? That does change the coding from preventative to diagnostic if you said, "my X is bothering me" and the doctor looked into that. Also if you saw a specialist instead of a PCP or GP, that will also change the coding.

Do speak with the office manager or whoever does the billing to find out what's going on and why it's taking so long. Ask specifically why it was billed as a problem visit rather than a yearly physical which is what you wanted. Ask what your diagnosis was because if it's a problem visit, you should have a specific diagnosis. Be polite but firm that you really want to know what's going on and how to fix this issue since you were under the impression that this was your yearly physical, nothing more
posted by Attackpanda at 1:32 PM on June 7, 2015

If you make another appointment the doctor will be forced to talk to you.
posted by bleep at 2:06 PM on June 7, 2015 [4 favorites]

I had this happen to me recently, hello mammogram and bone density tests! What I did was call the nurse's line at my doctor's office and she got it changed. This was after the whole hour-long phone call with the insurance company and them calling the doctor's office and they told them about it and then I called right away and the nurse did it for me (not the billing people).
posted by Marie Mon Dieu at 3:11 PM on June 7, 2015

Escalate to the practice manager.
posted by radioamy at 3:48 PM on June 7, 2015

The magic words that worked for me were "code review". Escalate as far as you can in the practice and insist that the codes be reviewed against your chart. I was able to eventually achieve this (to the tune of $400 waived as it was miscoded) on the phone without a lawyer but it took a lot of time and patience. You are in the right and they will make it so trying to get your records right! But persevere; good luck.
posted by stellaluna at 7:46 PM on June 7, 2015 [2 favorites]

« Older How to avoid traumatic encounter at wedding?   |   Good home owner repair web forums? Newer »
This thread is closed to new comments.