Do you think this is ethical? Dr and insurance issue

[Tap]

DD9 was scheduled for a neuropsych eval in July.  At the 1st appointment,  the child and parent meet the doctor for an hour and then the doctor determines which tests are to be done at future appointments. 

 

We met the doctor on a Thursday, and called the following Tuesday to schedule the testing.  I was told that the doctor left the practice unannounced and that they now had no one to do the testing.  It is now September and there is still no provider who can do the testing.   (ETA: just to clarify, only the intake was done, no testing.)

 

I got an $80 bill from them today for the evaluation appointment. That is the remaining after the insurance paid.   Do you think that I should be billed for the eval?  Yes, the eval was completed, but it is now useless. I am guessing that the doctor knew she was leaving the practice at the appointment since she quit the very next day.  The eval can't be sent to a new doctor because any doctor will want to make a list of their own tests. 

 

I am guessing I am legally responsible for the bill, but do you think it is ethical of them to bill me?   I am going to ask them to write off the bill, but if they don't, what would you do?

Edited September 7, 2016 by Tap

[Haiku]

I would complain to the state medical board. I find it unethical for a doctor to begin services that she knows will never, and can never, be completed.

[JustEm]

I would request that they waive the appointment fee and also complain to the state medical board.

[Farrar]

Um, totally not appropriate to get a bill. That seems completely absurd. Maybe a psychologist could weigh in, but I don't see how it's okay for them to bill you for what was basically the set up interview for a service that you were never provided.

[Lawana]

I would definitely ask for it to be written off on the basis of a promised plan of treatment that was not delivered. I would be angry if the practice refused, and would try to negotiate an extender period to pay, because I am too wussy to refuse to pay altogether.

 

Of course you never would have agreed to the evaluation at all if the further testing were unavailable.

[kbutton]

I don't have anything to add about the reimbursement, but you might be able to get a psych to look at the test results if they would make them available. Some tests cannot be run again right away, which makes it harder to get into a new person as well. You will miss the face-to-face observations, but you might get something from it. If you go that route, you should not have to pay the full price, for sure since it's not worth nearly as much.

[amo_mea_filiis.]

I don't have anything to add about the reimbursement, but you might be able to get a psych to look at the test results if they would make them available. Some tests cannot be run again right away, which makes it harder to get into a new person as well. You will miss the face-to-face observations, but you might get something from it. If you go that route, you should not have to pay the full price, for sure since it's not worth nearly as much.

Nothing was done. It was the intake interview to determine testing.

[magnificent_baby]

I would call and talk to the manager and/or billing; if you don't get anywhere, go higher than her/him. It is wrong to bill when that initial eval was required for future services that they are now unable to fulfill, especially since they cannot give you the records or documentation. 

Edited September 7, 2016 by magnificent_baby

[zoobie]

Absurd. I would fight that and make sure they didn't bill my insurance either!

[Guest]

I'd absolutely talk to billing and explain that the service essentially was null because it couldn't be used due to her leaving the practice a day after. If they didn't eat the bill I'd talk with the office manager, possibly in person, before filing a complaint against the business and possibly the license of the practitioner.

 

That's a last step though. Billing is first :)

[TechWife]

Legally and ethically, they have done nothing wrong. They billed for a service that was provided. I recommend that you contact the practice manager and ask if you will need to come in for another intake appointment since the original evaluator is no longer there, or if they will use the notes that the previous evaluator made to determine the tests needed. If the practice manager says yes, you will need another intake appointment, ask if it will be done at no charge or if you can get the charge for the first appointment taken off of the account. Either one of those would be a satisfactory solution, in my opinion. Your insurance company is likely not going to pay for two intake appointments with the same practice, so make sure you point that out. 

 

While you have the practice manager on the phone, make appointments for either the testing or the new intake appointment, whichever they say you need. I always made all of the appointments at one time: intake and two testing appointments. They were made with the understanding that if something needed to be changed after the intake, the other two appointment dates/times could be changed. Try to get all of the appointments made at one time. 

 

The doctor may or may not have known she was leaving the practice. There could have been an emergency or some action taken by the practice or her licensing board that required it. Does an internet search turn up any information on her?  

 

[LucyStoner]

The same thing happened to us after we had an intake for some ASD related therapy. The provider then flaked out and never scheduled us. But wanted us to pay for the initial intake. I called the billing person and made it clear the bill would not be being paid. I also reported them to my insurance company, the boy's secondary insurance and the state commissioner. No, you do not get $$ from me after getting up our hopes and then flaking out.

 

Do not pay the bill and tell them why. Then report them.

[Tap]

Legally and ethically, they have done nothing wrong. They billed for a service that was provided. I recommend that you contact the practice manager and ask if you will need to come in for another intake appointment since the original evaluator is no longer there, or if they will use the notes that the previous evaluator made to determine the tests needed. If the practice manager says yes, you will need another intake appointment, ask if it will be done at no charge or if you can get the charge for the first appointment taken off of the account. Either one of those would be a satisfactory solution, in my opinion. Your insurance company is likely not going to pay for two intake appointments with the same practice, so make sure you point that out. 

 

While you have the practice manager on the phone, make appointments for either the testing or the new intake appointment, whichever they say you need. I always made all of the appointments at one time: intake and two testing appointments. They were made with the understanding that if something needed to be changed after the intake, the other two appointment dates/times could be changed. Try to get all of the appointments made at one time. 

 

The doctor may or may not have known she was leaving the practice. There could have been an emergency or some action taken by the practice or her licensing board that required it. Does an internet search turn up any information on her?  

The office doesn't have another practitioner who can test, and doesn't have anyone set up yet to do so almost 2 months later.  I need the testing completed, so I have to move on to a different practice. I called to inquire about the results and was told that they were for in house use only.  

 

If there was an emergency, I would have expected the office to say so.  They told me "she quit without giving notice". No licensing issues that I am aware of, I don't recall her name so I would have to research to figure it out.  It isn't listed on the website any longer. 

[TechWife]

The office doesn't have another practitioner who can test, and doesn't have anyone set up yet to do so almost 2 months later.  I need the testing completed, so I have to move on to a different practice. I called to inquire about the results and was told that they were for in house use only.  

 

If there was an emergency, I would have expected the office to say so.  They told me "she quit without giving notice". No licensing issues that I am aware of, I don't recall her name so I would have to research to figure it out.  It isn't listed on the website any longer. 

 

In that case, call and tell them that you need them to refund the insurance company for the amount they paid and to take the copayment amount off of your account. 

 

I wouldn't expect the office to disclose either emergency information or licensing issues. What they have said is sufficient. Actually, "she is no longer with our practice" is sufficient. They really aren't going to be forthcoming with more information than that. Is the name of the practitioner on the explanation of benefits that you received from your insurance company? 

[Farrar]

I don't understand how they could be considered to have done nothing ethically wrong. To me this is like if you hired a contractor to come out and do a job for you. They say it will cost such and such and take two trips - one to measure and one to do the work. They come out for the first trip, take your measurements and ask for the first part of the money. You pay them and then they never show up again and never give you the measurements. That's basically what has happened here.

 

I get that it's not the office's fault. I get that they probably made the appt in good faith and were surprised by the doctor quitting. I get that they don't need to disclose anything else. But they didn't do anything. They just wasted her time. If they billed by mistake or without thinking about it, fine, whatever, seems like something that could happen. But why should she pay for nothing happening? It's not like her child received any benefit from that intake session.

[Tap]

In that case, call and tell them that you need them to refund the insurance company for the amount they paid and to take the copayment amount off of your account. 

 

I wouldn't expect the office to disclose either emergency information or licensing issues. What they have said is sufficient. Actually, "she is no longer with our practice" is sufficient. They really aren't going to be forthcoming with more information than that. Is the name of the practitioner on the explanation of benefits that you received from your insurance company? 

The office offered the fact that she quit without notice, so if there was an emergency, I would have expected them to say so. I work in the medical field, and it is common to say "The dr had an emergency and won't be in the office today".  It was obviously embarrassing for the office manager to tell me that she left me in a lurch, an emergency would have at least made it seem unforeseeable.  We had waited 3 months for this appointment. The manager and I had talked a few times before the appointment, so I wasn't a complete stranger to the practice.  It doesn't really matter why she left though.  Just that they are billing me for useless information. 

[AimeeM]

I would complain to the state medical board. I find it unethical for a doctor to begin services that she knows will never, and can never, be completed.

Well, the doctor didn't necessarily know it couldn't be completed - even if they knew they, personally, couldn't complete the services. He/she very likely assumed it would be carried out by their replacement.

 

We can't hold doctors to an impossible standard. For example, if it's unethical for a doctor to not begin services they can see through to the end, my son's first pulmonary specialist is unethical - he started DS7's roundup but left the practice a while later. Another pulmonologist took over (and tried to change the care plan, which we weren't happy with)... but the first pulmonologist can't be held responsible for that and we can't expect (especially specialists that often see people long-term and sometimes life-long) to see each and every single case through to the end. 

 

ETA: I think it's unethical of the PRACTICE to bill for this service and I would take this up with the practice.

Edited September 7, 2016 by AimeeM

[TXBeth]

If your insurance is anything like ours, they won't pay for another intake (parent interview appointment) for at least one year. So I would definitely work to get this taken off if possible so you can go somewhere else and get it covered.

[TechWife]

I don't understand how they could be considered to have done nothing ethically wrong. To me this is like if you hired a contractor to come out and do a job for you. They say it will cost such and such and take two trips - one to measure and one to do the work. They come out for the first trip, take your measurements and ask for the first part of the money. You pay them and then they never show up again and never give you the measurements. That's basically what has happened here.

 

 

 

That's not at all what happened here. They completed an intake visit, which was then billed to the insurance company. They did not bill for services not received, they did bill for services rendered. 

[melmichigan]

That's not at all what happened here. They completed an intake visit, which was then billed to the insurance company. They did not bill for services not received, they did bill for services rendered. 

This depends on the insurance company.  Our testing is lumped together, initial meeting, two testing appointments, all billed together.  If they submitted to the insurance company with those billing codes, then I couldn't get any testing covered for a year.  

 

In my mind it would depend on what they billed under.  If they billed as a simply office visit I would react differently, because that doesn't impede my ability to finish the testing, but simply reimburses them for the time.  Ethically, I think they should write it off.

Edited September 7, 2016 by melmichigan

[SKL]

I do think it stinks that you are being billed for something that is worthless to you.  So I support the idea of asking them to write it off.  However, I don't know how much of a chance you have for that to happen.  Good luck.

[Farrar]

That's not at all what happened here. They completed an intake visit, which was then billed to the insurance company. They did not bill for services not received, they did bill for services rendered. 

 

But it's an intake for a service that they stopped providing. And they don't intend to ever provide to Tap's kid. With notes and information that they don't seem to even have anymore. How is that a service that does anything for them? It might be legal to do it, but I fail to see how it's ethical.

 

ETA: Reading how apparently it may prevent them from using insurance to get the service from another provider (a necessity since this provider can't even do it) makes it seem even more clearly unethical. At least in my contractor analogy, you can then hire another contractor.

Edited September 7, 2016 by Farrar

[OneStepAtATime]

Legally and ethically, they have done nothing wrong. They billed for a service that was provided. I recommend that you contact the practice manager and ask if you will need to come in for another intake appointment since the original evaluator is no longer there, or if they will use the notes that the previous evaluator made to determine the tests needed. If the practice manager says yes, you will need another intake appointment, ask if it will be done at no charge or if you can get the charge for the first appointment taken off of the account. Either one of those would be a satisfactory solution, in my opinion. Your insurance company is likely not going to pay for two intake appointments with the same practice, so make sure you point that out. 

 

While you have the practice manager on the phone, make appointments for either the testing or the new intake appointment, whichever they say you need. I always made all of the appointments at one time: intake and two testing appointments. They were made with the understanding that if something needed to be changed after the intake, the other two appointment dates/times could be changed. Try to get all of the appointments made at one time. 

 

The doctor may or may not have known she was leaving the practice. There could have been an emergency or some action taken by the practice or her licensing board that required it. Does an internet search turn up any information on her?  

I disagree with the ethical part, depending on how the insurance is billed.

 

That's not at all what happened here. They completed an intake visit, which was then billed to the insurance company. They did not bill for services not received, they did bill for services rendered. 

This really depends on how this is billed to the insurance.  The two parts very well may be tied to each other and in billing for the one without being able to provide the other the practice may be blocking this family from getting the services their child needs.

 

This depends on the insurance company.  Our testing is lumped together, initial meeting, two testing appointments, all billed together.  If they submitted to the insurance company with those billing codes, then I couldn't get any testing covered for a year.  

 

In my mind it would depend on what they billed under.  If they billed as a simply office visit I would react differently, because that doesn't impede my ability to finish the testing, but simply reimburses them for the time.  Ethically, I think they should write it off.

 

 

But it's an intake for a service that they stopped providing. And they don't intend to ever provide to Tap's kid. With notes and information that they don't seem to even have anymore. How is that a service that does anything for them? It might be legal to do it, but I fail to see how it's ethical.

 

ETA: Reading how apparently it may prevent them from using insurance to get the service from another provider (a necessity since this provider can't even do it) makes it seem even more clearly unethical. At least in my contractor analogy, you can then hire another contractor.

 

 

Exactly this.  

 

The intake interview is frequently TIED to the evaluation.  (Our intake interview was definitely tied to the evaluation.) They are two parts of the same service.  It isn't like they can take that intake interview to another practice or that the intake interview helps the family in any way without the evaluation.  It is useless outside of that practice and its ONLY purpose is to determine what tests need to be run.  If OP's insurance was billed for the intake interview as part of evaluations but the practice can no longer do those evaluations then the child is very likely going to be prevented from actually getting the evaluations needed since they probably cannot schedule another intake interview for a year.  Basically, if the practice bills for the intake interview but cannot provide the evaluation then the OP's child has to wait A FULL YEAR to get the services they have already waited months for.  The practice may be doing something that is legal (no clue there) but it seems pretty unethical to me.

This depends on the insurance company.  Our testing is lumped together, initial meeting, two testing appointments, all billed together.  If they submitted to the insurance company with those billing codes, then I couldn't get any testing covered for a year.  

 

In my mind it would depend on what they billed under.  If they billed as a simply office visit I would react differently, because that doesn't impede my ability to finish the testing, but simply reimburses them for the time.  Ethically, I think they should write it off.

 

 

But it's an intake for a service that they stopped providing. And they don't intend to ever provide to Tap's kid. With notes and information that they don't seem to even have anymore. How is that a service that does anything for them? It might be legal to do it, but I fail to see how it's ethical.

 

ETA: Reading how apparently it may prevent them from using insurance to get the service from another provider (a necessity since this provider can't even do it) makes it seem even more clearly unethical. At least in my contractor analogy, you can then hire another contractor.

 

 

Exactly this.  The intake interview is frequently TIED to the evaluation.  (Our intake interview was definitely tied to the evaluation.) They are two parts of the same service.  If that is how the OP's insurance was billed then the child is going to be prevented from actually getting the services needed because the intake interview cannot be done by someone else outside the practice for a year but the practice no longer has anyone that can do the evaluation that was to follow the intake interview.  Basically, if they bill for the intake interview but cannot provide the evaluation then the OP's child has to wait A FULL YEAR to get the services they have already waited months for.  The practice may be doing something that is legal (no clue there) but it is definitely unethical.

[kiwik]

Ring them up. It could be that it simply didn't occur to anybody. If the first person entered that she had done the intake it would probably just be billed, no-one would have thought about it or even looked or noticed it.

 

Carelessness and lack of forethought are more common than deliberate acts. (Look up Asimov's law)

[LucyStoner]

That's not at all what happened here. They completed an intake visit, which was then billed to the insurance company. They did not bill for services not received, they did bill for services rendered.

An initial intake for an evaluation is not a service rendered on its own. Information is collected by the provider but no dx or report is available. It uses their insurance coverage (as usually only so many are covered in a year period) and the report was not furnished to the OP to take elsewhere. And everyone else will want to do their own anyways. So the OP would potentially need to pay OOP. The full amount her insurance paid for a useless appointment.

 

If it requires a short series of visits with the same provider that provider has no business initiating it unless they are handing their cases over to a partner and the parents are informed up front.

 

The provider who flaked on us got into some trouble. We weren't the only ones- he was meeting with a lot of people for the initial visits but not following up with matching and scheduling actual sessions. That's like a contractor charging everyone for the initial visit and never coming out to do the work for anyone.

 

Further it gets the hope up of parents and may have resulted in not taking an appointment when called off another waitlist.

 

It's a pretty nasty situation to be in as a parent who needs that eval done or services to commence.

[SparklyUnicorn]

That's really crappy.  There was a visit so yeah I guess they can bill for it, but good grief I don't blame you for not wanting to pay it. 

 

 

[BlsdMama]

Legally and ethically, they have done nothing wrong. They billed for a service that was provided. I recommend that you contact the practice manager and ask if you will need to come in for another intake appointment since the original evaluator is no longer there, or if they will use the notes that the previous evaluator made to determine the tests needed. If the practice manager says yes, you will need another intake appointment, ask if it will be done at no charge or if you can get the charge for the first appointment taken off of the account. Either one of those would be a satisfactory solution, in my opinion. Your insurance company is likely not going to pay for two intake appointments with the same practice, so make sure you point that out. 

 

While you have the practice manager on the phone, make appointments for either the testing or the new intake appointment, whichever they say you need. I always made all of the appointments at one time: intake and two testing appointments. They were made with the understanding that if something needed to be changed after the intake, the other two appointment dates/times could be changed. Try to get all of the appointments made at one time. 

 

The doctor may or may not have known she was leaving the practice. There could have been an emergency or some action taken by the practice or her licensing board that required it. Does an internet search turn up any information on her?  

 

 

I'd have to disagree just a little here.

 

A neuropsych eval is much more complicated than an office visit.  The intake is a chunk of the eval - you can't do more testing and evals without the intake and you can't just utilize an intake - any other office will require their own intake.

 

No, this is BEGINNING the process with no intention of ever completing it.  Imagine you went in for a pedicure and they began to paint your toe and announced the gal quit and you're done.  Please pay half the fee?  Are they kidding?  Will the next place even have the same color?  Nope.  You'll have to start all over.   See what I mean?

 

Yes, I think it was highly unethical.

[magnificent_baby]

Just another thought, since they won't give you the documentation, you may want to look up HIPAA laws. Part of that is your right to access the record. 

 

I still believe you should be refunded, as well as your insurance. This eval was required for future treatment; they did not fulfill their end of the deal. Keep making phone calls!

[TechWife]

I'd have to disagree just a little here.

 

A neuropsych eval is much more complicated than an office visit.  The intake is a chunk of the eval - you can't do more testing and evals without the intake and you can't just utilize an intake - any other office will require their own intake.

 

No, this is BEGINNING the process with no intention of ever completing it.  Imagine you went in for a pedicure and they began to paint your toe and announced the gal quit and you're done.  Please pay half the fee?  Are they kidding?  Will the next place even have the same color?  Nope.  You'll have to start all over.   See what I mean?

 

Yes, I think it was highly unethical.

 

I'm well aware of this.  I've done several intake appointments for my son's evaluations over the years. I've even done intake appointments where I decided not to use the evaluator for various reasons. I have no problem paying for any intake appointment where follow up is made available. As I stated previously, in this case, the OP needs to go back to the provider for a refund. 

[TechWife]

Just another thought, since they won't give you the documentation, you may want to look up HIPAA laws. Part of that is your right to access the record. 

 

I still believe you should be refunded, as well as your insurance. This eval was required for future treatment; they did not fulfill their end of the deal. Keep making phone calls!

 

It depends. If the notes are psychotherapy notes, then the patient does not have the right to them. I expect that is what may apply here since the OP is referring to the provider as a "doctor," indicating to me that the provider is likely a psychologist. 

 

http://www.hhs.gov/hipaa/for-individuals/medical-records/

[TechWife]

An initial intake for an evaluation is not a service rendered on its own. 

 

Actually, it is. There is no obligation on the part of the patient to return for future services. The clinician is collecting relevant, needed information. They aren't doing the appointment for kicks and giggles. 

[TechWife]

 

This really depends on how this is billed to the insurance.  The two parts very well may be tied to each other and in billing for the one without being able to provide the other the practice may be blocking this family from getting the services their child needs. 

 

 

Which is why I recommended to the OP that she contact the practice for a refund. In this case, it is appropriate. In other cases, it may not be. 

[TechWife]

dp

 

Edited September 7, 2016 by TechWife

[TechWife]

 

No, this is BEGINNING the process with no intention of ever completing it.  Imagine you went in for a pedicure and they began to paint your toe and announced the gal quit and you're done.  Please pay half the fee?  Are they kidding?  Will the next place even have the same color?  Nope.  You'll have to start all over.   See what I mean?

 

 

A neuropsych eval can in no way be compared to a manicure. They simply aren't the same in any way.

 

In any case, the intake interview was completed, which was why the bill was sent. In this particular case, the provider is unable to conduct the evaluations. As I stated previously, the OP should request a refund. 

[StephanieZ]

I think it's unethical, period, and you should not have to pay.

 

I would write them a short letter to that point, and I would call your insurance carrier and report the situation, to discourage the insurance from paying either. 

 

So, IMHO, if you have time and inclination, you should fight this.

 

Alternatively, life is short, you need to protect your credit, so it's not unreasonable to go ahead and pay it just for that. You don't owe it to the universe to right this wrong, but you are totally right, and they are totally wrong.

[TranquilMind]

I don't understand how they could be considered to have done nothing ethically wrong. To me this is like if you hired a contractor to come out and do a job for you. They say it will cost such and such and take two trips - one to measure and one to do the work. They come out for the first trip, take your measurements and ask for the first part of the money. You pay them and then they never show up again and never give you the measurements. That's basically what has happened here.

 

I get that it's not the office's fault. I get that they probably made the appt in good faith and were surprised by the doctor quitting. I get that they don't need to disclose anything else. But they didn't do anything. They just wasted her time. If they billed by mistake or without thinking about it, fine, whatever, seems like something that could happen. But why should she pay for nothing happening? It's not like her child received any benefit from that intake session.

If the contractor didn't start the job and didn't take your money, he might be a jerk but has done nothing legally actionable.  Ask me how I know.   If he took your money for work not performed, you have an actionable situation. This doctor took the money for the appointment that was performed. 

 

The doctor did the evaluation that particular appointment involved, even though she did not follow up.  The OP can ask that the appointment not be billed, but I would not expect to be accommodated, and if she is, great. 

[Farrar]

Actually, it is. There is no obligation on the part of the patient to return for future services. The clinician is collecting relevant, needed information. They aren't doing the appointment for kicks and giggles. 

 

But this is why I compared it to the contractor taking the measurements for the job. Of course it's work for the contractor (or the clinician in the analogy). Of course he should be paid for that part of the work and that time. But if a contractor takes those measurements and they're in some code that makes them useless to anyone else and he then takes your money and refuses to finish the job, then that seems unethical and wrong on its face. The contractor did work... but the work is useless to you. You receive nothing from it. You also didn't do it for kicks and giggles. But you don't get anything from it. And, as others are pointing out, you're then prevented in some cases from hiring anyone else for the work. It's like the contractor additionally blackballed you with other workers. I don't get how that's okay.

[Farrar]

If the contractor didn't start the job and didn't take your money, he might be a jerk but has done nothing legally actionable.  Ask me how I know.   If he took your money for work not performed, you have an actionable situation. This doctor took the money for the appointment that was performed. 

 

The doctor did the evaluation that particular appointment involved, even though she did not follow up.  The OP can ask that the appointment not be billed, but I would not expect to be accommodated, and if she is, great. 

 

That's why I made it for taking the measurements and not giving them to you. That's work, but it's work you get nothing out of unless the contractor then comes and uses them for the agreed upon cost. In this case, they can't even complete the job. I get that they did something... but... okay, let's say it's like having your portrait painted and not getting the portrait. You sat for it. The artist did the underlying sketch. And then wants money for the sketch and won't give it to you or finish the painting ever.

 

I just don't get how anyone is thinking that's okay. If she had received therapy of some kind but was dissatisfied because the psychologist couldn't come back and complete the therapy process, that would be cruddy for her, but she'd need to pay. This isn't like that.

[Bluegoat]

I think that, since they are actually unable to provide the service, ethically, and really from a good business perspective, they should not charge a fee.  It may be that it was all in good faith, no one expected the doctor to leave and perhps they thought they could get a replacement.  But you still don't charge for no service.

 

I'd talk to them first, and then the insurance people.

[TranquilMind]

But this is why I compared it to the contractor taking the measurements for the job. Of course it's work for the contractor (or the clinician in the analogy). Of course he should be paid for that part of the work and that time. But if a contractor takes those measurements and they're in some code that makes them useless to anyone else and he then takes your money and refuses to finish the job, then that seems unethical and wrong on its face. The contractor did work... but the work is useless to you. You receive nothing from it. You also didn't do it for kicks and giggles. But you don't get anything from it. And, as others are pointing out, you're then prevented in some cases from hiring anyone else for the work. It's like the contractor additionally blackballed you with other workers. I don't get how that's okay.

 

How would a contractor take measurements that are useless to anyone else? The space is the size it is.  Anyone can acquire that information. 

 

That isn't paid work.  If a contractor took money, and only took measurements, but never returned to do the actual job, you have a lawsuit.  That is not the work.  That is just prep. 

 

How would one be prevented from hiring someone else to do the job? I do it all the time.

I avoid paying up front though.  That is just never a good idea to let the money get out in front of the work, and the best contractors won't do this (unless you are doing an enormous job of tens of thousands, maybe). 

 

[Farrar]

How would a contractor take measurements that are useless to anyone else? The space is the size it is.  Anyone can acquire that information. 

 

That isn't paid work.  If a contractor took money, and only took measurements, but never returned to do the actual job, you have a lawsuit.  That is not the work.  That is just prep. 

 

How would one be prevented from hiring someone else to do the job? I do it all the time.

I avoid paying up front though.  That is just never a good idea to let the money get out in front of the work, and the best contractors won't do this (unless you are doing an enormous job of tens of thousands, maybe). 

 

 

I once had a contractor come, get paid to take the measurements and then not give them to me when I decided not to use their services. I was pretty ticked because the measurements would have allowed me to order the materials elsewhere and do part of the work myself. And I had paid for it as a service because I thought I was going to use them but then didn't like the price they had afterward for the work itself so I asked for the measurements and was told I wasn't entitled to them. (The company and I later worked it out, but it was a pain and involved a lot of yelling initially.)

 

I can't think of a way that a contractor could actually prevent you from getting the work done so the analogy is useless for that, but in this case, the OP may not be able to have her insurance pay for the service again because they've now been billed for it once this year. So she might be effectively closed out from having it done again for a long time - something people above shared have happened to them.

 

It was obviously not intentional fraud. Crap happens. But the first part of the service is useless without the second. It seems really unethical.

[TechWife]

But this is why I compared it to the contractor taking the measurements for the job. Of course it's work for the contractor (or the clinician in the analogy). Of course he should be paid for that part of the work and that time. But if a contractor takes those measurements and they're in some code that makes them useless to anyone else and he then takes your money and refuses to finish the job, then that seems unethical and wrong on its face. The contractor did work... but the work is useless to you. You receive nothing from it. You also didn't do it for kicks and giggles. But you don't get anything from it. And, as others are pointing out, you're then prevented in some cases from hiring anyone else for the work. It's like the contractor additionally blackballed you with other workers. I don't get how that's okay.

 

Because in this case the practitioner finished the job that was billed - the intake appointment! The OP is not being asked to pay for services that were not rendered. Reputable contractors do not request payment before the job is completed and taking measurements is part of the job. In your contractor example, the customer would be paying what we in our family call the "dummy tax." 

 

When we did our son's evals (multiple) - each time we were given a fee schedule that included separate fees for the intake appointment, the testing and the follow up appointment. Some providers may bundle these fees and some insurance companies may bundle these fees, but in this case it is clear that the provider is not bundling these fees. 

 

Because of the unique situation that the OP is in, with the provider's office being unable to schedule any follow up appointments, it is well within reason for the OP to ask the practice to refund the insurance company. However, there is nothing requiring the practice to do so. They have billed for services rendered. 

[Farrar]

Because in this case the practitioner finished the job that was billed - the intake appointment! The OP is not being asked to pay for services that were not rendered. Reputable contractors do not request payment before the job is completed and taking measurements is part of the job. In your contractor example, the customer would be paying what we in our family call the "dummy tax." 

 

When we did our son's evals (multiple) - each time we were given a fee schedule that included separate fees for the intake appointment, the testing and the follow up appointment. Some providers may bundle these fees and some insurance companies may bundle these fees, but in this case it is clear that the provider is not bundling these fees. 

 

Because of the unique situation that the OP is in, with the provider's office being unable to schedule any follow up appointments, it is well within reason for the OP to ask the practice to refund the insurance company. However, there is nothing requiring the practice to do so. They have billed for services rendered. 

 

The intake isn't a service that you can do anything with in and of itself though if they can't provide the second part. What you're saying implies that it's ethical to provide intake appointments with zero intention of ever doing the services. Someone above said they were the victim of a scam that was basically doing exactly that. I don't think that was the intention here, but then nothing happened. What if they had done the testing, which is work and time for them and then lost the results? Your reasoning implies they should still have to pay for it.

 

I can believe it's legal, I just can't accept that it's ethical or morally right to do that. If a business messes up, you shouldn't have to pay for them losing their only provider of the service you need.

[Bluegoat]

Because in this case the practitioner finished the job that was billed - the intake appointment! The OP is not being asked to pay for services that were not rendered. Reputable contractors do not request payment before the job is completed and taking measurements is part of the job. In your contractor example, the customer would be paying what we in our family call the "dummy tax." 

 

When we did our son's evals (multiple) - each time we were given a fee schedule that included separate fees for the intake appointment, the testing and the follow up appointment. Some providers may bundle these fees and some insurance companies may bundle these fees, but in this case it is clear that the provider is not bundling these fees. 

 

Because of the unique situation that the OP is in, with the provider's office being unable to schedule any follow up appointments, it is well within reason for the OP to ask the practice to refund the insurance company. However, there is nothing requiring the practice to do so. They have billed for services rendered. 

 

Yes, but the patient made the contract only in order to actually have the testing done.  The intake eval is actually totally useless on its own.

 

It's like I go in to a clinic for a skin anaysis to be set up for their proprietary make-up regime.  They say - if you pay us $10 for this set up appointment you can get our make-over next time which will cost $30.

 

If I agree, it is only because I want the make-over - I don't mind paying for the initial time only because I will get a result. 

 

If someone deliberatly set up a situation where that would happen, it would be considered fraudulent, a way to get your money without a service being rendered.  In this case, it isn't fraud, but there was still no service rendered. It's just bad practice to charge for it anyway.

 

I doubt the OP would have waited around 3 months for an appointment either - she could have been finding someone else during that time, so there is an element of them inadvertently wasting her time as well.

[TechWife]

Yes, but the patient made the contract only in order to actually have the testing done.  The intake eval is actually totally useless on its own.

 

 

 

The patient is under no obligation to return for future testing. Many don't, that's why there are charges for intake appointments. The alternative scenario is that a practitioner donates their time to people and may or may not ever be able to bill for their time if the person doesn't return. The intake eval is not useless on it's own - it is useful within that practice. Additionally, I have never taken part in an intake appointment where the practitioner didn't share their expertise with me - knowledge about child development, the testing process, etc., indicating to me that there is a benefit to the patient for participating in the appointment. 

 

I give up. 

[Bluegoat]

If the patient decides not to persue testing, she should undoubtably pay the bill.

[Lady Florida.]

Definitely call and ask about having it waived.

 

I think it's not only unethical for them to have billed you, but also to have billed and accepted payment from your insurance company. At the most you and your insurance company should be responsible for a basic office visit, nothing more.

 

ETA: I'm not saying they're legally or professionally in the wrong because I don't know. Just that it's not right. 

Edited September 7, 2016 by Lady Florida.

[Katy]

I didn't read all of the comments, but if they don't issue a refund or find another doctor to finish the evaluation I would call you insurance company and file a fraud complaint.

[katilac]

I think it's probably less of an ethical issue and more of a the-billing-is-automated issue. They will probably waive it if you call. If not, I would inform my insurance company and let them fight it out. 

 

 

[Tap]

Sorry, I haven't followed up. My laptop died, so I am borrowing my daughters.

 

The office billed me on purpose and says that the eval was completed, so they are charging me for it. they have no one who can do testing in the mean while.  I told the office manager that I thought it was unethical for them to bill me, and then the conversation changed so they never really addressed that. We have 2 private insurances and my daughter also has state insurance.  They had failed to bill the state, so they are going to do that.  If I get a bill to pay a portion myself, I will ask for a meeting with the owner. 

 

My main, private insurance, says that we have no restrictions on the amount of evaluations we can have in a year.  We do not need referrals, and even if it is the exact same type of appointment, they can put a note that it is a 2nd or 3rd opinion and it will be covered.  I am safe there at least.  

 

I really appreciate all the feedback.  It helps me to know that I am not off base, in thinking it was ridiculous.

 

To me: unless it was an emergency...... She quit the practice and walked out on us clients with zero notice. She should have not been taking new clients if she was in such a fragile state,(in her private or professional life) that she felt that the only way to deal with it was to completely walk away from her job and clients with zero notice. It took 3 months to get the appointment, so it is easy to see, that she was a busy doctor.  I can only guess how many clients she left high and dry with partially completed testing.  Leaving all of us clients holding the bag for her emotional mess.  That is unprofessional and to me, unethical as well.  She knew exactly what she was doing by having the office staff submit the claims to the insurance company. She knows that she provided a useless service and is being paid for it.  She knows that even if a new doctor replaces her in a timely manner, they will want a new eval to determine client needs.   She, nor the office, made zero attempt to contact me regarding the results or to issue a resignation letter. I am guessing she did the same with other families as well. I get resignation letters from doctors I haven't seen in years, because they are leaving a current practice and moving on.  That is the professional thing to do.  Quitting with out notice, especially on MENTAL health patients, is horrible.  I will be writing a letter to the state board, so at least if she does this again, there is documentation of a complaint.   Had she made any attempt to contact me. Had I been told there was an emergency, or an unexpected move.   Had the office bothered to contact me (I found out when I called them to schedule) or even send out a form letter, I would likely feel different about it.  But they didn't.  So I will be writing the letter to the board.