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Old 01-31-2003, 11:59 AM
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The Doctor Bill

Oct 30, 2002 - Mrs. Beaker and I were about 30 minutes into a movie when we heard a blood curdling scream from my 6 year old daughter's room. Not a "My sister took my doll!" kind of scream, a "I'm in f*cking pain!" kind of scream. So we rush towards her bedroom and meet her in the hallway as she was leaving her bedroom. Her right forearm is obviously broken. At about the midway point her forearm takes on a 60 degree angle.

I quickly scoop her up, my wife hands me a blanket to keep her warm (my daughter is in her pajamas) and I head out to the emergency room. After we arrive at the hospital the clerk in the emergency room takes our insurance information we get sent to radiology where a few X-rays are taken. Then we return to the one of the emergency treatment rooms complete with curtain door and medical paraphernalia. The attending nurse tells us that a specialist is needed and that an orthopedic surgeon has been called. She then goes through standard operating procedures taking her temperature, blood pressure and the like.

When the doctor (we'll call him Doctor A) arrives on the scene he briefly considers casting and setting the bone right away. My daughter doesn't do well in hospitals though and her fear (even with my and the wife's attempts at soothing her) is making it difficult for to proceed. Finally he decides to put a splint on the arm and tells us to come in early, early, early tomorrow morning (it was rather late at night) for treatment as he has an 8 hour surgery planned the next day. We follow his instructions, bring her in the next day and the surgeon does a superlative job at setting her bones while my daughter is under anesthesia.

Fast forward a couple of months. The Doctor's bill all told is around $1025 out of pocket (a big chunk of that filled up the deductible). The anesthesiologist's bill was around $60 (much less since insurance kicked in after meeting the deductible). It's Christmas and things are kind of tight but I have no compunctions about sending a good chunk of my bonus off to these guys. My family is very important to me and the entire medical staff were professional and competent. I have no complaints. So, I send off $700 to the Doctor in December and then another $200 in January and I pay off the anesthesiologist completely. I still owe some money to Doctor A but I'm not receiving much pressure since I'm willing and able to pay (it just takes some time that's all).

Last week I received a bill for $182 for the emergency room visit from a different doctor. Let's call him Doctor B. I have no idea who Doctor B is. I do not recognize his name, cannot picture his face, nothing. I have no memory of this person. "Hmmmm, that's strange" I think to myself. So I decide to contact the number listed on the bill and inquire about it. The billing employee at the other end of the phone works for a company located in Oklahoma (hint: I don't live in Oklahoma). She tells me that the bill is for "services rendered" by the attending emergency physician. I tell her that she's mistaken and that no services were rendered by a physician of that name at that date and time (I was with my daughter 100% of the time that night). She tells me that that's what she sees on her screen and that if the doctor made a phone call to a specialist that could very well account for the charge in question.

So I decide to call the business office of the hospital where I took my daughter. After speaking with the director he confirms that Doctor B has filled out paperwork indicating he was the emergency physician and that he performed an "emergency evaluation". Apparently Doctor B is a self employed physician at several hospitals and has no office. The director is apologetic but can't provide me with any contact information for Doctor B and is only able to give me the phone number for the Oklahoma billing company which the doctor uses (and which I already have). I decide to get all copies of patient information pertinent to my daughter's visit from their Patient Records department so I call the director and leave a message. That was about 30 minutes ago.

My thinking is that Doctor B simply, as a matter of procedure, automatically fills out a bill for every patient who sets foot in the emergency room for a nanosecond regardless of whether he actually did *anything*.

Summary. The hospital doesn't really have any information and can't really help me since Doctor B is a self employed professional with no office. I have no contact number for Doctor B except to a billing entity out of state which has no information about what went on that night except for what appears on their screen.

Conclusion. I'm probably screwed.

I am angry and frustrated. I know this is the pit but I choose not to rant at this time since I don't know if what I'm experiencing is malice, incompetence, or just a really screwed up system. But, I'll say it again. I'm angry and frustrated.

Grim
Old 01-31-2003, 12:27 PM
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Sadly, I'm not at all surprised by this. Little wonder why health care costs are so incredibly expensive.

A few years ago Mr. Honey had day-surgery for a hernia. When we received the bill a couple of weeks later we called and requested an itemized bill. We were amazed to see that we were being charged over $10 for each Tylenol (500 mg, not with codeine) given to him.
Old 01-31-2003, 12:53 PM
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Were you by any chance seen by a P.A. (physician's assistant), or a nurse practitioner? CrazyCatLady was seen in the ER last summer for a syncopal episode (she has petit mal seizures) and got a bill from the emergency physicians group for ~$250...even though the only MD she saw was me. (This is not to mention that they brought her to the hospital where I work, 45 minutes away from where she was, instead of the one in Lexington, resulting in a $500 ambulance bill...but I digress.)

Quote:
We were amazed to see that we were being charged over $10 for each Tylenol (500 mg, not with codeine) given to him.
What's even funnier is that hospitals get Tylenol for free. That way the hospitals don't have any reason to use generic acetaminophen, and Tylenol can still claim to be "the pain reliever doctors use most".

As an intern, I am so far removed from the billing end of things that I have no idea what anything costs. I was trying to get a ballpark figure a while back on what a night on the telemetry unit costs for someone being admitted for chest pain, and no one could tell me...the lady in the billing office said that she knew, but she couldn't give me that information unless I came down, filled out a few pages of forms, and waited three business days. I can't make this stuff up.

Dr. J
Old 01-31-2003, 01:29 PM
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Instead of a payment, can you just enclose your question and a request for doctor B to contact you and explain the charge in the return envelope you were sent?
Old 01-31-2003, 01:42 PM
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I suppose I could lieu. I plan on contacting the billing company in Oklahoma again and asking them to review the account. When I call I'll try to get a contact number for Doctor B as my first preference is to simply beat the shi... er, establish a dialogue with him about the nature of the charges. However, getting communication down in writing is never a bad idea either. Incidentally, my daughter is healing well and the cast is off.

Grim
Old 01-31-2003, 02:05 PM
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Re-reading your story, I'll tell you what he did--he ordered the x-ray, then looked at it and decided to call the orthopod. Still, if neither he nor a physician extender (man, I hate that term) saw you, I seriously doubt he can bill you. (Don't quote me on any of this.)

Dr. J
Old 01-31-2003, 04:02 PM
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This is what royally pissing me off after reading a thread about this weeks ago.

When I go to an 'in-system' hospital, I assumed all doctors/nurses/floorsweepers...there were 'in-system' for health insurance. Therefore all deductables, etc. apply.

Then I find out that a doctor can look at you and he is not 'in-system' and can bill you outside of the insurance. If you work in a hospital then you had god damned better be part of the system.

Doctor B wouldn't get a cent out of me. He would have to drag my skinny, white ass into court if he wants the money.

I can't find the other thread but the guy had the same problem and it ran into thousands of dollars.
Old 01-31-2003, 05:31 PM
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Contact your insurance company and explain this to them.

Odds are they might not know about it and the doctor is screwing both you AND them -- screwing them being what might cause action -- they might do something.
Old 01-31-2003, 05:52 PM
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I would request in writing from the billing company an itemized bill from Dr B.

Can you ask Dr A who Dr B is?

I'm glad the Li'l Grim Beaker is doing well. How did she break her arm, any way?
Old 01-31-2003, 06:15 PM
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Details on that are sketchy ivylass. My older daughter (age 8) was a witness to the incident and things still aren't clear. Apparently li'l Beaker jumped off the bed (or maybe it was the laundry hamper, it seems to change) and she landed wrong.

Grim
Old 02-01-2003, 12:02 AM
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Let me play Devil's Advocate a little here about the tylenol bill. What you have to realize is that when you pay for the tylenol, part of that charge includes a portion of the salaries of the pharmacist who dispenses it, the nurse who administers it, the paper and pens that the doctor writes the order for tylenol on, etc. When you get an itemized bill, they cannot list all fo the incredible overhead that a hospital generates and they choose to spread it out over all the other costs (although I think they could just put in a general charge for "overhead").

Now, about Dr. B-I agree that he may be charging for his time reading the X-ray and talking on the telephone to the orthopedist (damn-I KNEW I should have gone into a lucrative field like ER) but if he didn't write a note in the chart he is screwed. No note=no service performed in medicine. Ask for a copy of the ER chart and if there is nothing there with his name on it, then refuse to pay unless he proved he provided a service.
Old 02-01-2003, 12:37 AM
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psychobunny--is it possible to bill a patient you didn't see? (For a visit, that is--otherwise, radiologists would never get paid.) If my Junior G-Man's understanding is correct, you'd have a hard time billing Medicare/Medicaid for such a non-visit, but I don't know if you can get away with it in the real world. (95% of my patients are in one of the above categories or have no intention of paying anyway, so it really never comes up.)

Dr. J
Old 02-01-2003, 12:46 AM
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You can't bill a patient if you have never had any contact with them. Some doctors do bill for "telephone visits", and medicare will pay for things like management of home care patients but whatever you do you must DOCUMENT or you won't get paid.
Old 02-01-2003, 08:32 AM
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I'm a medical billing specialist, so this thread piqued my interest.

A couple questions first. Is it possible that Dr. B is a radiologist? "Emergency physician" doesn't really tell me anything because any MD working in an ER can fit that description, and because you didn't mention a bill from the radiologist. Is it also possible that he saw your daughter when you weren't with her (maybe en route to an x-ray)?

psychobunny is right. Unless the physician actually saw the patient, he can't bill for a visit. What constitutes a visit has a very specific definition, one component of which involves an actual examination. (Phone calls, conferences, paperwork, and the like are billed using completely different codes.)

I doubt that the bill was for a nurse practitioner or physician assistant, because they can bill under their own name and identifier and the claim and bill would have that person's name and credential, not Dr. B, MD.

As for the relationship between the doctor and the hospital, it's not uncommon for the MD to be part of a private practice that provides services under contract to the hospital. Doctors who aren't hospital staff (that is, they are not employed by the hospital) are entitled to bill for their services separately from the hospital bill. Some hospitals, in fact, have signs posted letting you know this. And, to make life simpler and cheaper on the doctor's practice, the billing company exists to file insurance and send out statements. They don't have any information on the specifics of the service and only bill out what they're told.

I would do a couple of things. I'd get on the phone with the billing service and ask them to review the charges with you to explain EXACTLY what was billed. You'll also want to get the records. In order to actually get medical records, you've got to go to the hospital and sign a release. There may also be a fee for the copies. Look for something called an ER note, although read all notes by all MDs, as well as X-ray and pathology reports.

If Dr. B does not have a note or any documentation that he saw the patient, talk to your insurance company and contest the claim. Send COPIES (not the originals) of the record to the insurance that support your story and ask that the claim be denied. Send a letter to the billing service informing them that you're contesting the charge pending record review. Send it certified, return receipt requested to make sure they get it, and you've got proof that they've gotten it.

If you like, I can help you understand what's going on so far and help you break it down. It's a frustrating and infuriating process, but the mystery can be solved. My e-mail is below.

Robin
Old 02-01-2003, 08:39 AM
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Quote:
Originally posted by DoctorJ
psychobunny--is it possible to bill a patient you didn't see? (For a visit, that is--otherwise, radiologists would never get paid.) If my Junior G-Man's understanding is correct, you'd have a hard time billing Medicare/Medicaid for such a non-visit, but I don't know if you can get away with it in the real world. (95% of my patients are in one of the above categories or have no intention of paying anyway, so it really never comes up.)

Dr. J
Under very limited circumstances, a physician may bill a service, even though he didn't actually see the patient. Conferences with other providers or with the patient's family fall under this. These would be billed using different CPT codes than a visit, however. Truthfully, without seeing exactly how this visit was billed, I can't really make a determination if it may be valid or not.

Radiologists and pathologists, by definition, don't see patients, and their coding reflects this, so they don't really count.

Robin
Old 02-01-2003, 11:56 PM
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Something I didn't see mentioned - if he is billing fraudulently, its likely he's doing it to others, and he hasn't been caught. It seems suspicious that he's so difficult to get in touch with (perhaps by design, to discourage you from looking into your bill).

I wonder if there is some type of review board you can report him to if you find out you've been billed incorrectly. Are there organizations that investigate billing practices?

Or maybe I just read too many Robin Cook novels.
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Old 02-02-2003, 12:49 AM
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And don't forget, the markup on things such as Tylenol also includes the 100 indigent patients before you that day who received Tylenol. They can't/won't pay for it so someone has to. Not to mention the Medicare patients for whom the hospital only gets reimbursed a fraction of their costs.

Welcome to not-for-profit healthcare.
Old 02-02-2003, 08:43 AM
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Quote:
Originally posted by sperfur
Something I didn't see mentioned - if he is billing fraudulently, its likely he's doing it to others, and he hasn't been caught. It seems suspicious that he's so difficult to get in touch with (perhaps by design, to discourage you from looking into your bill).

I wonder if there is some type of review board you can report him to if you find out you've been billed incorrectly. Are there organizations that investigate billing practices?

Or maybe I just read too many Robin Cook novels.
Actually, yes. If this doctor is billing fraudulently, then the insurance company is very interested in this. Most of them have fraud departments that investigate this kind of thing.

And, in case you're interested, the penalty for Medicare fraud is $50,000 per occurence and possible dismissal from the program. If the Feds decide to prosecute, the guy risks prison time, additional fines, and losing his license to practice.

As a practical matter, however, it's getting much harder to commit fraud, because of new laws on the books requiring such things as documentation for services rendered. (And, in most states, deliberately altering a medical record is a crime in and of itself.)

Robin
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