Advice- my d&c Dr. and insurance rip off

dhreczuck · May 2012

Hi Ladies- I've been really troubled by the claims that were submitted to my insurance company by the Dr. that completed my d&c. Sorry this is long.

I was referred by my High Risk OB to anr office that handles d&c's, elective and nonelective, because he was going on vacation for a week and wouldn't be able to complete the d&c. I followed up w/ several different dr's and all were either out of network or would require at least a week or more wait to do the procedure.

So I decided to go with his referral since I wanted to get it done asap. On the day of the d&c they charged me $550 and said it was the contracted rate through my OB's office since it was referral. They said they would still submit to my insurance but would only accept what got reimbursed, they wouldn't bill me any unpaid amounts.

I didn't even think twice about it for a long time and then happened to look at my insurance claim. They billed my insurance a total of $30k in claims for my 5 minute d&c. This is clearly fraud on some level, no d&c costs that much money. My insurance only covered $1,500 of it. I haven't received any further billing from the d&c office, and I'm nervous if I say anything they will bill me (I was hysterical that day and signed off on the standard forms, I'm sure somewhere in there I agreed to pay anything not covered by insurance and I wouldn't have any recourse).

It makes me sick to my stomach to think they are over charging to such a high degree to make money off of my m/c. I was thinking of filing a consumer complaint but I'm not even sure I have cause to. What would you do?

10-4LilBuddy · May 2012

Wow. That is horrible. I would start talking to your insurance company. See if there's any advocate that you can get to help you. Try to gain an ally at your insurance company. The forms you get from insurance can be misleading. I remember thinking that I was charged $10K for a series of EKGs and my insurance person was able to help me figure it out. Ask them how much this procedure should cost. They have a database of procedures and the average costs. This will give you some leverage when you call the dr's office.

If it turns out to be what they billed you, then I would contact the dr's office. They will eventually try to bill you for it, so it would be better for you to take the offensive vs. defense. Approach it from the point of view that this must be a clerical error.

If that doesn't clear it up, contact your state's attorney general's office. They can help you figure out where this belongs. Good luck.

dhreczuck · May 2012

Thank you, I never thought about contacting the attorney general. There are a ton of reviews of this office most of which were posted AFTER my d&c unfortunately that have similiar if not identical stories. They are commiting fraud on a large scale. I was told that the only reason they would bill me is if the insurance company reimbursed me directly for the claim and not the Dr.s office.

I would never pay any bill they send me, obviously I wouldn't have the means to anyway! The d&c I had in 2011 was only a total of $3K, also out of network and that charge included anthesia as well..

JennyP1 · May 2012

I'm so sorry you have to deal with all of this in the midst of recovering from a m/c. I absolutely HATE dealing with the insurance and dr. office billing. I fought my insurance company for 11 mos over charges from having my son. He was nearly 1 year old when I finally got it resolved because I got fed up and and submitted my issue to the Better Business Bureau.

If you get to that point please consider writing a letter to the BBB. They take these issues seriously even if the Dr. office or Ins. company aren't members of the BBB. They give the company a chance to resolve the issue and if they don't it gets publicly reported against them. I find that most companies care about their reputation and will work with you to resolve it so as not to have a bad report on the BBB.

Good luck with all of this and try not to stress too much over it...and I agree with the PP that you should take the offensive and start calling around to gather info and DOCUMENT EVERYTHING (names of who you spoke to, dates, what they told you, etc...)

MAtoNC · May 2012

Wow, that sucks.

If you look at your EOB (explanation of benefits from the procedure), it should have a column that says what they billed, another that says what the insurance covered, and yet a third that says what the doctor (hospital, whatever) is allowed to bill you.

That is the first thing to look at. As sickening as this whole thing is, I bet that the third column on your EOB say "$0.00".

Basically, if the hospital agrees to take your insurance, then they are also agreeing to the "negotiated rates" that they have with the insurance company. The hospital/Doctor's office is agreeing to accept the amount from the insurance company and NOT bill you for more.

That price tag is criminal.

dhreczuck · May 2012

Thanks, I looked at my claims, they submitted two seperate ones, 1 for $5000, and 1 for $28K. My insurance covered $300 of the 5K one and approx $1700 of the $28K one. The remaining balances show in the patient reponsibility column, meaning what they can bill me. The Dr's office is also out of network, I do have out of network coverage which is why the got reimbursed a small amount, but for that reason I don't believe they have contracted rates.

When I saw the initial claim pending I called the Dr.s office and essentially flipped out, the billing women told me that because they have a special arrangment w/ my OB's office for referrals, that they would not charge me the patient responsiblity portion. I'm not buying it though. I have yet to see a bill for any of the services, so that's why I'm hesitant to start digging with fear of stirring up the hornets nest.

mtlaurel · May 2012

I would also contact the OB that made the referral. Ask about what their out-of-network rates would be for the same procedure. And, explain your concerns about the office that they referred you to. It might help you find some answers, and at least, get them to stop referring patients. Not what you need, but better to try to get to the bottom of it then have it rear its ugly head down the road some day. Good luck.

danieleandwayne · May 2012

I have a hard time believing that your insurance company-- not known for their generous natures, being bastions of capitalism-- would not have flagged that doctor's office for billing such an outrageous amount.

I'd start with them.

I agree w/ pps as well about contacting the attorney general, the BBB, and your OB who referred you.

If the doc's office tries to come after you for the rest of the $30k, I'd explain to them that not only were you told you were not responsible for whatever the insurance doesn't pay because of some referral agreement, but that also you are well aware of the standard cost of a D&C and that your D&C was standard so that if the office wanted to pursue this matter, they would next be talking to your lawyer.

That is disgusting.

MrsTRAV · May 2012

danieleandwayne:
I have a hard time believing that your insurance company-- not known for their generous natures, being bastions of capitalism-- would not have flagged that doctor's office for billing such an outrageous amount.
I'd start with them.
I agree w/ pps as well about contacting the attorney general, the BBB, and your OB who referred you.
If the doc's office tries to come after you for the rest of the $30k, I'd explain to them that not only were you told you were not responsible for whatever the insurance doesn't pay because of some referral agreement, but that also you are well aware of the standard cost of a D&C and that your D&C was standard so that if the office wanted to pursue this matter, they would next be talking to your lawyer.
That is disgusting.

I agree, and that's so terrible I'm sure you're not the only person that office took advantage of.

MarylandWed · May 2012

10-4LilBuddy:

Wow. That is horrible. I would start talking to your insurance company. See if there's any advocate that you can get to help you. Try to gain an ally at your insurance company. The forms you get from insurance can be misleading. I remember thinking that I was charged $10K for a series of EKGs and my insurance person was able to help me figure it out. Ask them how much this procedure should cost. They have a database of procedures and the average costs. This will give you some leverage when you call the dr's office.

If it turns out to be what they billed you, then I would contact the dr's office. They will eventually try to bill you for it, so it would be better for you to take the offensive vs. defense. Approach it from the point of view that this must be a clerical error.

If that doesn't clear it up, contact your state's attorney general's office. They can help you figure out where this belongs. Good luck.

agree with all this. wow.

Strunella · May 2012

I would sit tight until you receive a bill. They can bill your insurance for a million dollars, but obviously the insurance company is only going to pay their agreed upon amount. So, they're not really gaining anything unless they actually send you a bill for the remaining amount. My recent D&C was over $12,000 at an in-network facility, and I ended up paying $500 for it. So many papers fly back and forth, I never make a move until I actually receive a bill. In the event you do get a crazy bill, check to see if your company has a patient advocate for employees. My company advocate will handle just about everything insurance related and has been a huge help and a wonderful liaison between our insurance company, other third parties and me.

livinitup · May 2012

dhreczuck:

Whhen I saw the initial claim pending I called the Dr.s office and essentially flipped out, the billing women told me that because they have a special arrangment w/ my OB's office for referrals, that they would not charge me the patient responsiblity portion. I'm not buying it though. I have yet to see a bill for any of the services, so that's why I'm hesitant to start digging with fear of stirring up the hornets nest.

Why don't you believe the employee? They've said it twice and you haven't received a bill. You both all have the same paperwork, right? They know what they are getting from the insurance company. What's the point of a surprise bill after they have repeatedly told you they would accept insurance payment only. Wouldn't it be in their interest to tell you that you will be billed? Why keep it a secret?

If you want to be more confident, then get it in writing. Send an email detailing your conversation (twice) and ask for a return reply with a follow-up confirmation.

Want a personalized experience?

Advice- my d&c Dr. and insurance rip off

Re: Advice- my d&amp;c Dr. and insurance rip off

Choose Another Board

Search Boards

Want a personalized experience?

Advice- my d&amp;c Dr. and insurance rip off

Re: Advice- my d&amp;amp;c Dr. and insurance rip off

Choose Another Board

Search Boards

Advice- my d&c Dr. and insurance rip off

Re: Advice- my d&c Dr. and insurance rip off