Do you think this is ethical? Dr and insurance issue

[Guest]

I don't 'like' this but I think you're doing the right thing given the additional information and conversation. What a headache for you though :(

 

I'm glad you can get another eval at least! That's one small silver lining to the crap cloud.

[G5052]

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. 

 

Yes, you paid for the doctor's time and office expenses even if it ended there. 

 

If you went to a surgeon for a consult and ended up not booking surgery, you'd still pay for it. If you later went to another surgeon to see about surgery, they'd want to reevaluate and work out their approach on their own.

 

Believe me, I hate paying for anything I don't use, but there it is. 

[magnificent_baby]

Yes, you paid for the doctor's time and office expenses even if it ended there. 

 

If you went to a surgeon for a consult and ended up not booking surgery, you'd still pay for it. If you later went to another surgeon to see about surgery, they'd want to reevaluate and work out their approach on their own.

 

Believe me, I hate paying for anything I don't use, but there it is. 

 

The difference here is there is no one there to do the next step, so the initial eval is a waste of time as she will have to start over again. Just as in your surgeon example, if the surgeon suddenly quit, you would have to start over with a new consult. I still stand by my opinion that she nor the insurance should be billed. 

[Farrar]

Yes, you paid for the doctor's time and office expenses even if it ended there. 

 

If you went to a surgeon for a consult and ended up not booking surgery, you'd still pay for it. If you later went to another surgeon to see about surgery, they'd want to reevaluate and work out their approach on their own.

 

Believe me, I hate paying for anything I don't use, but there it is. 

 

But should the surgeon charge you if he assessed that you needed surgery then refused to provide it? It's not that she didn't book it, it's that the doctor cannot provide the service they were assessing for.

[Soror]

I would be writing a letter as well. I'm curious as to what in the world they charged for the initial assessment if they are still charging you $800 after the insurance. IIRC our initial assessment was $250 or something, with the total being $2k+. I could see a fee somewhere in that neighborhood perhaps but not $800+.

[TechWife]

But should the surgeon charge you if he assessed that you needed surgery then refused to provide it? It's not that she didn't book it, it's that the doctor cannot provide the service they were assessing for.

 

Yes. Oftentimes, surgeons don't know what is needed until they assess the patient. That is the purpose of the assessment. A surgeon may not do the type of surgery needed, they may not have room in their schedule, they may be going on vacation, they may not think they can do an adequate job, they may worry, based on their discussion, that the surgery is a lawsuit waiting to happen. They can also quit their jobs without notice. In all of these cases, the surgeon has done the job and has assessed the patient. 

[Janeway]

I do not think it is ethical. You are paying for a full eval, which they failed to complete. The doctor walked out in the middle of the job. If a doctor does half a surgery and walks out, do you still pay? No. So why would you pay for this? I would complain to them and to the insurance company.

[Bluegoat]

Yes. Oftentimes, surgeons don't know what is needed until they assess the patient. That is the purpose of the assessment. A surgeon may not do the type of surgery needed, they may not have room in their schedule, they may be going on vacation, they may not think they can do an adequate job, they may worry, based on their discussion, that the surgery is a lawsuit waiting to happen. They can also quit their jobs without notice. In all of these cases, the surgeon has done the job and has assessed the patient. 

 

The bolded is the difference.  In this case, the assessment wasn't really the job.

[zoobie]

I don't see anything on point in the FAQ and 7.03 on departure only deals with providing notice and access to records, not billing. I would call and get guidance on the best way to complain. Your state may have a similar service.

 

Please call (312) 464-4823 and ask to speak with a staff member from the Council on Ethical and Judicial Affairs

 

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/frequently-asked-questions.page?

Edited September 9, 2016 by zoobie

[ktgrok]

I think it really depends on what was billed. If it was billed for more than an office visit, no, not ethical as all they did was the office visit. If it was billed just as an office visit (even a long one) then well,you got what you paid for. However, given the amount I saw mentioned, it seems it was billed as the testing too?