Can a health car provider do this?

sharlanetMarch 22, 2004

A couple months ago, my son had an ear infection so we took him to the doctor. We have no insurance and always pay at the time of the visit, which my husband did. He paid the full amount they told him to pay. Today we received a bill for $14 that said it was 30 days past due. This is the first knowledge we've had about owing anything additional. We called them and they said they made a mistake and indeed we owed the additional $14. (they conveniently tacked on a $.50 service fee for being over 30 days late.) Okay, there was no insurance or anything to complicate the office visit bill, so why are they changing their minds how much to charge us? Can they do this? Do we have to pay the additional $14? And how dare they say we're late with the payment when his is the first bill we've received? Who can I contact to file a complaint (besides a manager in the billing office)? Is there a State Board or someone I can contact? What would you suggest I do? Just pay it and not fight it?

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I share your frustration with medical billing, having had several similar incidents, both with and without health insurance coverage. I'm convinced the people at both the doctors offices and the insurance companies are simply guessing what to charge, there doesn't seem to be a coherent system in place. I found it impossible to get an accurate estimate of charges beforehand when I was paying out of pocket.

It's outrageous that they tacked on a finance charge.

Personally, I'd pay the $14 (but not the finance charge) and be done with it because my past experience with fighting these things was so upsetting. Perhaps in the future when writing out a check for medical bills, you could add "check represents payment in full when endorsed" on the notation line? Would that work?

You could try contacting one of the doctors at the office, perhaps by sending a letter of complaint via registered mail. In my experience, medical staff will do anything to keep the doctor from getting involved in clerical snafus. Although that'd probably make future visits to that office pretty uncomfortable.

    Bookmark   March 23, 2004 at 4:26PM
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Your husband paid the bill the doctor's office presented to him at the time the services were rendered and the office accepted the payment. That's the end of the story. No one who renders services can come back to a patient or client and try to shake more money out of them after a bill has been paid in full. The doctor's office is totally out of line.

I'd demand that they drop the whole thing immediately and let them know your aware of your rights. Tell them you're prepared to file a complaint with the county medical society, if necessary. There's no need to be nasty with them, but you must be firm. Talk directly to the doctor, if necessary. My guess is that they'll back down because the amount is so trivial.

    Bookmark   March 24, 2004 at 10:58AM
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Having worked for a doctor I can attest to the fact that sometimes errors in charges are made. I can understand your receiving a bill for the additional charges but an explanation for additional billing should have been included. There should not have been a late payment charge. That's ridiculous. But, if you're thinking about not paying it, consider if you had been overcharged $14 and a refund check were issued to you. Would you refuse to cash it? This did happen in our office and the money was reimbursed with a note of apology.

    Bookmark   March 28, 2004 at 4:55PM
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This is an all too common occurrence with health care providers. You can dispute the bill and refuse to pay. Call the office and ask to speak to the billing department. Tell them calmly but firmly that you were told the full amount at the time of service and that you paid it. Tell them that you are disputing the new charge and the late fee and that you are prepared to lodge a complaint with the state if they continue to bill you for this extra charge. This should take care of it. Fourteen dollars is not a trivial amount to a family trying to get by without health insurance.

    Bookmark   March 28, 2004 at 9:36PM
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I work in a counseling office that uses health insurance, county-supplied funding for low income people without insurance, and cash-basis patient-pay for those who have none of the above. You would be amazed to see the huge difference in what insurance companies pay for the same services. As a contractor, I get a percentage of whatever comes in for each visit for each client. A service that one insurance company will pay $115 for will get us $62 from another and $67 from the county. (What irks me no end is that a first-time appointment with a customer with blue cross will bring in $100+ if the client is there for a mental health problem, but only $52 if it is a substance abuse problem! It is more work and takes more forms to do the substance abuse work, but we are paid far less.)

My point is that the insurance companies decide what the medical clinics are paid. Our "cash price" even varies, based on the income of the person receiving services. Plus, the person checking out the client at the end of the visit does not get the complete story at the time the client is leaving the clinic. My paperwork is not done until the end of the day, and is entered in the computer the following day. So if a new client comes in and is told that the appointment will cost $70 and pays that before I meet with them, there may other costs (a urine drug test, a breathalyzer test) that are incurred during the client's time with me. The front office folks have no way to guess what will be provided once the session starts, so cannot really give a fixed price to anyone. Plus, once the client is with me, we may get into something that causes the session to run long and that can get the client into being charged for a longer session. Also, the client may call and make an appointment saying they have a mental health concern (perhaps depression) and I learn halfway through the session that there is also a drug or alcohol problem. If I judge that the substance abuse is the primary problem, then anything the client was told about the cost of their "mental health" care is out the window because the two problems have two different payment schedules! It is all infuriating. Even when we call and check on the insurance coverage before the meeting, the insurance company can change their reimbursement if they find that there was a mistake made in what they quoted to us.

I guess my point is that in the medical world, it is very rare to be able to set a price up front for things. Cerrtainly with insurance, but even for cash-paying clients. For instance, if the base cost of the visit was $x and you paid $x up front, the clinic may also charge you for the cost of drawing blood for a test (one of my docs gets $5 for every time that is done, and the charge is listed under "surgery.") or for the use of swabs, bandages or bandaging, injections.... you get the idea.

Because most medical billing is done off site (often by someone working at home, or in Bangalore India, or a main office of a group of clinics), the folks at the front desk at the time of service may not even have access to the charges you just incurred! It seems to be the only kind of business that can spend your money for you without having you agree to the cost of something! When I paid cash for services, I was amazed that I could get bills for blood tests that I didn't even know I was having done. After all, the phlebotomist can tell you she is pulling so many vials of blood with such a color cap, but I will guarantee that she does not have access to the cost of each of those vials. The medical world is accustomed to waiting for the billing office to tell them what the charge will be (and usually this is determined by the insurance company) and they are less geared toward providing services to folks who pay cash up front. They seem to have the attitude that it is OKAY to just spring additional costs on someone.

If I were you I would call the billing office and ask what the additional charges are for. Make sure that this additional service was done. If it was, agree to pay the bill, but then refuse to pay the late fee because you were not offered the chance to pay for that service at the time of the visit and because this is the first bill you have received. Then politely suggest that a schedule of such costs be made available at the office for the desk workers to be able to provide these costs to people there for services. Then, in the miracle case that this happens, be prepared that such a list is always outdated and that it will cost you more than they stated.

    Bookmark   June 12, 2004 at 10:02PM
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I spent one night in intensive care about two years ago and was overcharged $500+ for services I never even received. When I got the bill, it never listed what any of the charges were for. I had to ask for a breakdown of the charges and this is when I discovered the error. My insurance company overpay the hospital, the hospital had to reimburse my insurance company and now the hospital is trying to charge me this extra $500+. My insurance company told me to only pay what they sent me on the insurance statement from THEM not the hospital, which is what I intend to do.

I would find out what this extra charge is for. I would document in writing to the billing department (call & get a name and address to send your letter to), and I would even send them a copy of the canceled check where you paid your bill in full. If they refuse to remove the charge, then you will probably have to pay it or start getting phone calls from a bill collector.

    Bookmark   June 13, 2004 at 9:06PM
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