Monday, April 9, 2018

Doctors Aren’t Always Right But Some Doctors Just Want Their Money (10 Months Later)

Last June, I went to the worst rheumatologist appointment ever (Read: The Storm After Years Of Calm).  And I thought, now that I have a new rheumatologist that I like, that I had put it behind me.  But to my surprise and chagrin, a few weeks ago, I received an explanation of benefits from my insurance company stating that I owe over $300 for labs that my insurance plan isn’t paying for.

First of all, why am I getting billed for this now?  It is April of 2018 and this appointment occurred in June of 2017.  Second of all, no, just no.

I will not be taken advantage of this way, especially since after the tests were run, I found out what they were and they were totally unnecessary.  Tests were run for multiple myeloma (makes no sense), and for a doctor that didn’t seem to believe I have lupus and RA, she ran no confirmatory tests for the illnesses that I ACTUALLY HAVE (Read: I Do Have Lupus And RA After All...).

So I contacted the person who is our designated contact at the insurance company.  She proceeded to attempt to school me on what a deductible is and that mine hadn’t been met yet, hence the charges.  I calmly explained that I know what a deductible is and all of that, but that’s not what I was questioning.  I asked if I could appeal, and was told that I had 60 days from the date of service to appeal.  I asked how it was fair that I could be billed for services 10 months later but only had 60 days to appeal?  We continued to go back and forth, with her being incredibly dismissive and disrespectful to me.  I finally asked to be contacted by a supervisor.  I’m still waiting.

(Also note that since this appointment took place last year, it would have counted toward that deductible, which I met.).

I also contacted the person that administers our insurance, and was told that my best bet was to contact the provider.  I explained that in order to spare myself further mental anguish, that was definitely not an option.  In fact, I have attempted, on at least six occasions, to contact the medical group administration, without success.

I have no intention of engaging with this provider ever again.  And I have no intention of paying any bill I receive now for lab work or anything else associated with that appointment.  It’s nearly a year later at this point.  And I was trying to move on from that appointment, which set me back a lot, both physically and emotionally.

It is unbelievable to me that doctors can provide subpar care and nothing can be done about it, unless it gets to the level where you have a lawsuit.  It seems that, that is the only way that patients can get any sort of vindication.  I can’t reason with a terrible provider.  I can’t get a direct line to anyone at the office above the provider.  I can’t get any assistance from my insurance company.  So what am I supposed to do?

I would love to work for an insurance company and advocate for patients in my position.  I would love to be able to contact a provider and say “you have to write off this bill because the patient was not treated well, and neither them nor we are going to pay for it.”

Clearly, there is a reason why I have not and will never see this provider again.  It is not like I have gone back multiple times to see her.  And I pay all my bills.  As long as the services are rendered properly, I have no problem paying.  But when services are rendered far below where they should be, I am going to fight that, especially when I had assumed that everything was done and paid for.  It’s a bit strange that 10 months later they are coming after me for money, but this provider has never contacted me to see if I was coming back to see her again or not.  I guess the loathing was mutual.

It’s also interesting because my insurance is claiming that they’re not paying due to the diagnostic codes.  Which brings me back to the beginning.  Of course, because the tests don’t make sense for the diagnoses I have and am being (successfully) treated for.  So you see, I am being sent in circles.  Once I knew what tests were run - after they were done and I saw the results - I knew they were totally unnecessary.  But this doctor was so convinced that she was right and I was wrong that she went on a very pointless (and expensive) fishing expedition.

And this is where the medical profession and the insurance industry get it wrong.  That this doctor’s experience in medical school trumps my near decade as a patient living with lupus and RA is absolutely ridiculous.  And that I should be the one to have to pay for the fragility of her ego is even more ridiculous.  She made an error.  It was a grievous one, but thankfully I’ve had a (correct) diagnosis for long enough to know that she was wrong and that I wouldn’t put up with that kind of treatment from any physician.  So I cut my losses, now she needs to cut hers.


  1. Gosh I have no idea what to do in a situation like this. Usually I suggest personnel but it looks like you have gone that way with no success. But with the wrong Dx code I cannot imagine the insurance company would have any more sway than you are.

    The next step after not paying is collections. So I might suggest an attorney to write a letter to notify them you refuse to pay the bill for the reasons you stated. After that your next move might be to wait. So frustrating.

  2. Can you write a letter to the medical provider stating the reasons that you would like this to be written off.. and to receive confirmation from their office that said bill has been zero'ed out? Maybe make a stink... contact local newspapers/radio stations/ tv stations to see if you can get help with "calling out" this doctor for their absurd practices and then billing you almost a year later. Also, can you utilize YELP, GOOGLE... etc.. to post warning reviews to others that might want to get treated by this doctor? Maybe the louder your warnings, the more serious this office will take your requests?

  3. I remember the post you wrote about that visit. I was angry then, I'm livid now. I can't believe you have to go through this. Sending <3

  4. You can report this quack to the medical board. The board that gives them their medical license (it's done by state.) They have to investigate the complaint. You'd be saving her future patients a lot of trouble if they could be reprimanded. If you have a good PCP you could ask them how to report?

  5. I've been nurse for 35 years. I've reported doctors and dentists to state board of medicine and dentistry. I have also reported them to the attorney general ( for Medicaid fraud) and to the better business bureau. I think you should also see if Arthritis and Lupus federal organizations has patient advocate. I think your insurance company probably would be least likely to help as they won't have to pay the bill if you are forced to. I'm really sorry . I am a autoimmune sufferer myself and have gotten up at the rotten rhuematologists mid sentence and walked out. Clearly he wasn't listening and it was a waste of my money n time. I refused to pay a bill for services not rendered and that was 19 years ago. Never showed up on my credit report either. You can also write a letter to have added to your credit report, so as to be ate it if it shows up on your credit.

  6. Being a nurse and then becoming a physician, I am so sorry. I have gone through this for many years, having had RA since I was a child. But until after menopause, I felt that I could control it, no longer! RA has flared up with a vengence!!! I also went through a pile of rude and inadequate physicians, now I have found someone who is just fabulous! So then he tells me he is going to retire soon! Oh no!!! Then the other hassle is getting refills for pain medication. With the few people who are abusing them, it is making it more difficult for those of us who really need them to function!