Advice for Stupid Doctor (long)

calindi

So two years ago, I was having back pain and my boyfriend recommended his chiropractor (we were under the same insurance plan, since we worked for the same company).  Great doctor, bit of a creep.  He said that if I received letters from my insurance company saying they weren't covering part of the total, not to worry because he typically billed more than he expected to get because he knew they'd always pay less than what he requested.  He said he'd never make me pay the overload of what the insurance company didn't pay.  So I got a few letters, but I ignored them.  I was just out of college and had never really managed my own healthcare, so I just trusted him.  Silly me.

A year passes (yep, a whole freaking year), and I was no longer living at my old address and had a new phone number.  BF had already moved down to FL to start law school.  I was visiting BF when I saw he had a letter from this doctor - I opened it up to find a letter to ME!  Addressed to BF at his address.  Yeah, totally a HIPAA violation as I had NEVER given this doctor permission to contact BF about medical issues (and how was he supposed to know if we were even still dating a year later?).  The letter said I owed the doctor $400 or he was going to send it to collections.  Newly unemployed, I was petrified and broke down crying and called him to find out what the heck was going on (I never should have called him).  Through a series of voicemails that we exchanged (never actually spoke), he said that my insurance company wasn't paying him.  I called the insurance, they said they'd pay him, but he didn't put my member code on the claim.  So I got my member code from them (I was on a totally new insurance at this time), and called up his office and left my member code on his voicemail, telling him that the insurance company said they would pay his bill if he refiled it with that member code on it.

Then another 14 months pass... and he's calling me again!  He's having this shy, quiet secretary call and make collections, so I feel bad yelling at her.  So far, I've just skipped his phone calls (I screen my calls anyway) and they've gone to voicemail.  But the jerk is saying I still owe him the money - where the heck has he been for 14 months?!  I'm so furious, you can't believe it.

So BF (being the law student) wants to file a complaint with HIPAA about this doctor sending my confidential medical information to someone (BF) who had never been given access to that information by the patient (me).  And he wants to file a complaint for insurance fraud, since the doctor had told us both separately on different occasions that he overbills the insurance company regularly.  I just want the jerk to leave me the heck alone, but I'd hate to have him keep doing this to other people!

I'm debating calling him up and saying, "Listen, you jerk.  Two years ago, you told me that you intentionally overbill insurance companies.  Then you waited a YEAR after my last service to try to contact me about a bill the insurance company rejected - you sent a letter about my confidential medical procedures and billing to someone who I had NOT been given HIPAA authorization.  After I magnanimously contacted the insurance company on your behalf a YEAR after the services had been rendered, they said they'd pay you if you included my member code.  I called back and gave you my member code and did not hear from you for over a year.  TWO YEARS!  I doubt the insurance company will do anything for you now, this long afterwards, but I'll call one last time.  But I will not pay you a penny - what I will do, if you don't stop harassing me, is report you for HIPAA violations for mailing my medical information to an individual who I had been dating when I was your patient and had no authorization, and for insurance fraud for the multiple times that you told me that you intentionally overbill them.  So I'm going to call my old insurance company one last time, and then I never want to hear from you again."

Too much?  How would you handle it?  What would you say or not say?  Would you report him for either the HIPAA violation or insurance fraud?

PaigeMcC

That would be exactly how I would respond.  Also, do you have records of the calls? Notes?E-mails?Voicemails?  Those might be good to hang on to JIC.

niknik15

He sounds terrible! What you suggest sounds like what needs to be done, although I would make sure to get him on the phone and not go through his secretary. You might check to see if he is under the BBB and file a claim with them?

Hazel_B

That is nuts. I would likely respond the same way. I agree with Paige about trying to keep record of what has been going on.

Blue & White

I'd definitely report him to HIPAA (you have written proof..) - accusing him of insurance fraud is going to be harder to prove, but the fact he filed your claim without your member number suggests at least some insurance incompetance.  My sister has been working in medical offices filing claims successfully since an internship she had in high school - it's not rocket science.

Good luck with this all.  Being the ballless creature I am, I might just pay it and deal with it after.  I am not a fan of collections.  But after two years, I probably wouldn't pay it. 

calindi

When it came in a year ago, I was nervous about collections and wanted to make it right.  If my insurance had told me then that they weren't covering it, I probably would have paid it.  But they told me that they WOULD pay it, and that they had told him that they'd pay it when he could provide a member number.  So when I gave him my member number, I figured it was all over.  Silly me, I also figured not hearing from him for 14 months meant he had figured it out!!! 

So now I'm just pissed.  And I won't pay him a cent.  I just didn't know if it was too much to say that, and if I should or shouldn't report him for HIPAA violations and insurance fraud. 

LizzyTish88

I would defiantly go for the HIPAA violation, and try for insurance fraud. You can't be the only patient that he has done this to. HIPAA is there for these reasons, and I suggest you use them. Let us know how it goes!

bourgehm

Wow, that is just terrible. I don't get why he would even be such a jerk. I would totally report him (or at least say you're going to). I'm sure he'll quit calling you once you threaten to report it. And, you'd win.

loves2shop4shoes

I'd tell him exactly what you said.  Don't yell or act emotional though.  Just be very matter of fact.  This way, he's more likely to take you seriously.  It's hard to take a crazy, emotional person seriously.

Hazel_B

If you can somehow arrange to straighten things out via phone, just ensure that you can get that $400 off your credit report...you don't want that to come back and haunt you in a couple of years down the road when you want to buy a house or something.

marleylikeair

Cate, I would definitely sit on this and cool down over the weekend. Also, take that time to gather all the documentation you have on this, I'd you haven't done so already. I've had some similar issues that I ultimately got resolved; I'll come back to this thread and go into some more detail in a little while--have to do some stuff first.

marleylikeair

Okay. So here's my take, based on my experience.

You can't just give the doctor one last courtesy of calling the insurance company one more time. Believe me, if the doctor is about to send this into collections, and the insurance company is being a bonehead, in order for you to get this taken care of without it affecting your credit score, you are probably in for several more phone calls back and forth. IMO, threatening him with reports to HIPPA and of insurance fraud is only going to make him less likely to cooperate with you. (Save that for after this is all taken care of; PPs are right--you're going to want to report him so there's a chance he'll stop doing this to others.)

Based on my experience, you're going to need to do some or all of the following...

A) Start by calling the insurance company again. Be polite, but firm. As long as they still say that yes, they'll pay, confirm whether they've received the resubmitted form with your member code on it. (If they say they won't pay, skip to option . I suspect they haven't received it, or will say they haven't. If that's the case, tell them you will have the doctor's office fax it over ASAP, and ask what their fax number is.

Then, call the doctor's office every other freakin' day until you get him or someone in billing on the phone. Be polite, be congenial, but firm. Ask them to resubmit it, and give them the member code again. Ask them to call you when they've got it successfully faxed over. They probably won't call you, but they'll know you mean business. Then, keep on top of them until they say that yes, they've sent the fax.

Then, call the insurance company again and confirm they've received the fax. Ask how long it will take to have the bill taken care of, as you have been told your bill is about to be sent into collections. Again, be cordial, but firm. If they say two weeks, call the doctor in two weeks or so to see if they've received payment. If they say they haven't, call the insurance company and ask when it was sent or will be sent. Call the doctor's office again and let them know the ETA.

When, finally, the doctor's office's billing department says it's taken care of, get something in writing from them saying your balance is paid.

Now then. If they say no, let them know you would like to file an appeal of that decision, and ask where and to whose attention you should send it. Here's what happened when I did that...

I had a situation not too long ago where I'd talked to someone at my then-insurance company, and they'd told me I was covered for outpatient care at a hospital for up to $10,000. I went to the ER to have some severe pain from a sprain looked at, and I ended up with $800 in bills, which my insurance company then told me was not covered, becase actually, that $10K was for inpatient services, not outpatient. NICE. (I was on a really minimal plan at the time.) I told them I would never have gone to the ER if their representative had told me I had no outpatient coverage.

So the person I was talking to recommended I write an appeal, and put as much detail in it as I could, like who I talked to if possible, or at least whether it was a male or female, and when. I wrote up a detailed letter and sent it where they told me to. I was very polite in the letter, but very clear. At the end, I wrote something like, "I would prefer not to have to take this matter to small claims court or to report this to the Better Business Bureau, but I have all the necessary documentation, and I will if I have to." Then, of course, thanked them for their time, blah, blah, blah. They sent a letter back saying no, but here was all the information needed for a second appeal. I appealed again, and this time, they agreed to pay. TADA!

Basically? Hound them. Hound them all. But with a proverbial smile on your face. If all of this fails, then go to the mattresses and pull out your threats.

Good luck. I know just how frustrating this all can be. Let us know how it pans out!

It just occurred to me that you might already have called and talked to the doc today, and all this might be useless for your current situation...but oh well. Maybe it will help you or someone else at some other point in time.

AbigailMS

I would definitely report to HIPAA. I work in a pharmacy and he'll get into big trouble with that alone. They take things like that VERY seriously...especially if they can tell it wasn't an accident. (which I'm assuming it wasn't, since it wasn't like they sent it to your old address or anything innocent like that.)

calindi

Thanks, ladies.  Marley, I haven't called yet - I wanted to calm down a bit.

I did all that the last time we did this game - his office said they had the information, the insurance company said as soon as they received the document with the member ID, they'd pay it.  I gave his office the member ID, and the fax #, and dropped it.

I've put in a request with the insurance company for all claims from this doctor - if he didn't submit another claim 14 months ago, then it's his own damned fault.  The insurance company will not accept any claims at this point as it's over 2 years since the service.

To be honest, I think he's double dipping.  I think he got the money from insurance, and is trying to get me to pay more.  But I won't know until I get the paperwork.  And I've already submitted a report with the credit bureaus regarding the situation, so hopefully it won't affect my credit too much.  Additionally, I'm not overly worried about my credit score as BF has an incredible credit rating, and mine's quite good, too, so even that small hit isn't worth paying the $400.

marleylikeair

In Response to <a href="http://forums.theknot.com/Sites/theknot/Pages/Main.aspx/special-topic-wedding-boards_not-engaged-yet_advice-stupid-doctor-long?plckFindPostKey=Cat:Special%20Topic%20Wedding%20BoardsForum:136Discussion:5a3f0287-6b00-4b0b-9fb4-39c90059c236Post:1184f574-906a-436c-8cd1-ef19b9ded3ce">Re: Advice for Stupid Doctor (long)</a>:
[QUOTE]Thanks, ladies.  Marley, I haven't called yet - I wanted to calm down a bit. I did all that the last time we did this game - his office said they had the information, the insurance company said as soon as they received the document with the member ID, they'd pay it.  I gave his office the member ID, and the fax #, and dropped it. I've put in a request with the insurance company for all claims from this doctor - if he didn't submit another claim 14 months ago, then it's his own damned fault.  The insurance company will not accept any claims at this point as it's over 2 years since the service. To be honest, I think he's double dipping.  I think he got the money from insurance, and is trying to get me to pay more.  But I won't know until I get the paperwork.  And I've already submitted a report with the credit bureaus regarding the situation, so hopefully it won't affect my credit too much.  Additionally, I'm not overly worried about my credit score as BF has an incredible credit rating, and mine's quite good, too, so even that small hit isn't worth paying the $400.
Posted by calindi[/QUOTE]<div>
</div><div>Glad you took the time to calm down! I know in your situation, I would have been tempted to call right away, and your rant (well, the stuff you were thinking about saying to the doctor) sounded exactly like something I would have written.</div><div>
</div><div>Wow--you are braver than I am about the whole credit score thing! I'd never want to take that hit. But I'm sure your credit score is a lot better than mine--I messed up some stuff when I had my first credit card, right out of college. There was some stuff I just didn't know. (They should really have a required how-to-protect-your-credit class in high school, just like sex ed!) I'm hyper-vigilant now. Glad you mentioned submitting a report to the credit bureaus--I don't think I was aware a person could do that, and I'll definitely be keeping that in mind.</div><div>
</div><div>I'll be interested to know what happens when you get that paperwork in hand! Keep us/me posted!</div>

whitelilly1010

i'm not sure if you have taken care of the situation but I thought I would throw out my thoughts.  I've worked for several medical offices and am currently going for my doctorate.  Warning though...this is long.  I apologize in advance.

As far as the confidentiality matter goes, it would really depend on the situation.  From what I gathered you were on the same insurance plan with your BF.  Was your BF the primary card holder?  If so you may not have as strong of a case unless the letter specifically stated personal information about your care.  I won't go into all of the logistics but there are basically some loopholes in the privacy acts.  Not that he was right to address anything to your BF but he would have a defense to his actions that are not unreasonable to the laws applied.  Not that you do not have a case either though.  As I said it would depend on a few factors.
 
I'm not sure you would have a case for over charging the insurance for services rendered either.  He has a right to charge as he wishes then to charge any remaining balance to the patient.  Even though he told you he would waive charging you personally I'm sure he would say otherwise if asked about it.

I would bet there are other things he is doing though such as charging insurance for services he is not providing to patients (such as therapies), charging for patients who did not even come in that day, not keeping adequate records to support his claims if the insurance company checked into it, etc. etc.

I would recommend doing the following...after you have gathered the information from you insurance company look to see if anything is out of the ordinary.  Did he charge for any services not rendered?  At this point in time it will be hard to determine on your own if the days or adjustments are off so it would probably have to be something obvious (i.e. did he charge for traction and you never received any therapies, were you on vacation on of the days he says you were in for treatment?)

I would also call and request your complete file from the chiropractic office.  Don't make the conversation any longer than that.  If you want to make it even more intimidating for them...have your FI send them a request for it on legal letterhead.  They are legally responsible to hold medical records for seven years.  From the sounds of it his office is not very organized if they could not bill your insurance for 2 years.  So you may catch him on that with little effort.  If they have it that's fine...you may be able to gather more information and you caused more work for them.

Then I would calmly call and ask to speak to the Doctor about your current situation.  If you have found a flaw...great...bring it up.  The rest of the sitation would depend on what you want.  You could ask him to take you out of collections and rectify your credit report or you will see him in court.  If you do not find anything that is okay too...tell him you would like to rectify the situation or you will be forced to have your lawyer, who is already reviewing the records on your case, the insurance companies, and other patients get involved.  There are a lot of ways you could go about this.  Like I said...it would depend on your end goal.

I hate doctors (in any area) like this...I say shut him down if you can.  Hope this helps and best of luck!  I'd love to hear updates as well if you don't mind.

calindi

I gotta say, I kind of rolled my eyes when I saw a post this long after the original post, but you gave me some really good advice and I appreciate it!

The one thing - the insurance.  We had the same insurance policy (as in we both has Aetna) as we worked for the same company, but we had only just started dating - my policy was not in any way connected to his, nor had I signed any agreements giving him access to my medical records.  So he was a bad, bad boy when he sent my files to my boyfriend.  He had no way of knowing if we were even still dating, as it was over a year later.

He also has disappeared again - he will probably pop up again in a year.  I checked with the credit bureau, and no report has been filed, so I'm guessing he knows he doesn't have a leg to stand on anyway.

whitelilly1010

Okay...that makes more sense now about the insurance.  How incompetent or just stupid of him.  There are slower months for Doctors this time of year due to the holidays and patients not wanting to pay co-pays or deductiblesvwhich start over.  Plus taxes being due which some do not save for.  So he is probably trying to grab whatever he can.  Sleezy!!