sunny64
03-11-2008, 01:14 PM
I fractured the three small toes of my right foot. My doctor charged for x-rays plus almost $300. per toe. There was no treatment - no bandages, casts or medication given. Total bill was almost $900.00. When I asked if there was a mistake in their bill, they said "lady, if you broke both legs, should the doctor only charge you for one?" My insurance company reduced the eligable amount to be paid, but I still had to pay almost $400.00 for what amounted to a diagnosis only. Can they morally, ethically and legally charge for treatment that wasn't done???
:confused:
:confused:
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janewhite1
03-11-2008, 02:26 PM
He charged $900 dollars plus the cost of x-rays for one visit? That is unusual, and I probably would not visit that doctor again.
Whether it is legal, I can't say. Certainly he's not required to actually do something just because you go to him. If he thinks the toes are better off being left alone to heal, then that's up to him, and charging for diagnosis only is acceptable.
The only issue I have is the size of the bill. It should be based on what tests and procedures were performed and how long the doctor spent with you, not what the diagnosis was!
Whether it is legal, I can't say. Certainly he's not required to actually do something just because you go to him. If he thinks the toes are better off being left alone to heal, then that's up to him, and charging for diagnosis only is acceptable.
The only issue I have is the size of the bill. It should be based on what tests and procedures were performed and how long the doctor spent with you, not what the diagnosis was!
RightFootMary
03-11-2008, 06:20 PM
Hi Sunny - I take it you do not have an insurance plan with "participating" and "non-participating" doctors. I guess a doctor can charge whatever he feels like (which doesn't sound right but I know it is). Is there any chance you can speak right with the dr? I have done that on occasion and found out that the dr had no idea what charges were submitted and what was covered and his "office staff" was just trying to get as much as they could and I have had the dr say that he would accept whatever the insurance paid as payment in full. It's worth trying unless you just want to "eat" the cost and never go to this person again.
Good luck.
Mary in NY
Good luck.
Mary in NY
sunny64
03-11-2008, 07:43 PM
Hi Mary,
Yes I have health insurance (PPO) and he was a participating doctor. Even though my insurance reduced the total amount to be paid, I was responsible for all of it because I had not met my deductable yet. My complaint is that he charged $282.00 for each toe that he did not treat. Other people have said that that is beyond belief. My insurance company would not get involved because they did not have to put out any money. I did protest the charges, but other than to file a formal complaint it did no good.
No, I will never go back to that doctor because of his rude office staff.
Thanks for your feedback.
Yes I have health insurance (PPO) and he was a participating doctor. Even though my insurance reduced the total amount to be paid, I was responsible for all of it because I had not met my deductable yet. My complaint is that he charged $282.00 for each toe that he did not treat. Other people have said that that is beyond belief. My insurance company would not get involved because they did not have to put out any money. I did protest the charges, but other than to file a formal complaint it did no good.
No, I will never go back to that doctor because of his rude office staff.
Thanks for your feedback.
geggar
03-12-2008, 12:20 AM
I would like to know what procedure codes he used to even be able to bill that amount. If no treatment was rendered then the only thing he should be able to bill for would be a new patient office visit and the x-rays. Are you sure he didn't close reduce the fractures (I would think you would remember that)? It doesn't sound like he did anything that could possibly billed per toe. I think you got charged surgery codes which is not right and should be rectified. You should be able to call your insurance company and see what procedures were billed and then get it rectified. They are right that the doc may not have any idea that you were billed for this because if he did intentionally bill for what sounds like surgery charges and none were performed that is insurance fraud.
sunny64
03-12-2008, 06:45 PM
The procedure codes that were used for billing were 28510T7, 28510T8 and 28510T9 for treatment of toe fracture @ $282.00 each toe.
geggar
03-13-2008, 02:57 PM
Those are the codes for closed treatment of fractured toes without manipulation.
That to me means the toes were just wrapped or splinted straight. I personally have never billed for doing that and wouldn't feel right about doing it. To charge that is plain rediculous. Hopefully the insurance company will deny payment. I would be calling the insurance company about it and also talk to the doctor directly about it and ask him if he knows what was billed. If he does and says that is what he deserves to be paid then would complain to the insurance company and to the state medical board. I'm completely going on your side of the story here so if he did something to the toes then although the rate is in my opinion excessive he is entitled to bill something for it.
That to me means the toes were just wrapped or splinted straight. I personally have never billed for doing that and wouldn't feel right about doing it. To charge that is plain rediculous. Hopefully the insurance company will deny payment. I would be calling the insurance company about it and also talk to the doctor directly about it and ask him if he knows what was billed. If he does and says that is what he deserves to be paid then would complain to the insurance company and to the state medical board. I'm completely going on your side of the story here so if he did something to the toes then although the rate is in my opinion excessive he is entitled to bill something for it.