Not Sure What to Do....
Hi! I've never done this before, but here goes....
Post-Pandemic Quarantine, my Pulmonologist of 7 years (or his staff) is now over charging my insurance and giving my in July gave my Xoliar prescription (shipped to his office) to another patient and told me I ran out. I didn't!
My understand is this behavior is not only unethical, but illegal.
His office has always been a hot mess, but now it's out of control. He's a great doctor. A little unconventional, but he has done more for me than any other doctor. From what I gather, he's not big on managing his business, he just wants to take care of his patients. As noble as that may be, it's as frustrating.
I brought my recent concerns to his attention. He was horrified at my Xolair prescription being given away and said he would rectify that. I already did....I pulled my prescription, had it sent to my house and have learned to self-inject. As for the insurance fraud (relatively minor, as this time), he said he'd "waive" the charges. I pointed out that I did not receive the care, so therefore he was not waiving, but correcting the charges. He agreed.....and told me he'd have his billing person call me.
Before I left the office, I told my Pulmonologist that I'd hate to lose him as my doctor, but I could not tolerate this behavior. He agreed, told me he has lost other patients and would absolutely make this right.
Almost a month later, no one has reached out from his office and my insurance charges were not corrected. I did receive a bill shortly after and paid part of it and wrote on the invoice that I would not pay the remainder until someone called and explained the charges, as I requested of my doctor......crickets!
So....I ask you, the Asthma Community, what would you do? You know what it's like to find a good doctor, you don't want to let go. But would you tolerate your insurance being over charged? Would you tolerate your extremely expensive drugs being given away....and all the other drama I have endured? Is it really better on the other side?
Your advice is appreciated.
sm
Hi SMurphy, and thanks for your post. I hope others in the community will chime in when they read your comment and respond with shared experiences of their own.
This is quite the puzzle, that's for sure!
I also have something to contribute from my own personal experience. I have found myself in similar situations over the years, with several doctors. These are doctors with whom I have enjoyed years of professional care who also are not tuned in (at all), to the business end of their practice. They prefer to devote their time and energy (as yours does), to their patients and their patient practice.
Like you, I, too, have had issues (although they are not common, by any stretch), with insurance, billing, invoicing, and payments. When these (rare) issues arise, I find I can always arrive at a resolution by interacting with the physician's billing office, or the insurance company, or both, depending on the circumstances.
Do you think this might work for you in this situation you've shared here with the community?
Wishing you well,
Leon (site moderator asthma.net)Unfortunately I have experienced this problem. I've, too, really felt my Doctor was very professional and more knowledgeable than any other Pulmonologist in the area. He was gentle and compassionate. But his office was a mess! Making appts. then "losing" them when you show up. Overbilling! Short visits billed as extended visits, procedures that were never performed, etc. When I called the billing office, they said it what was the Doctor had put down on the charge sheet and they couldn't change until he made any changes. And they wouldn't ask him. They were very rude. The more they talked the louder their voice went up.
So I made a list of the disputed items, only 7. My next visit was just a check-up. I took the extra time telling him how much I appreciated his care but there was an issue I needed to discuss with him. I related what I felt were the overcharges. He referred to his computer records and compared them to my list. Upon completion, he changed the charges. He apologized for the errors and the attitude of his staff. He said he would have his staff make the corrections ASAP. I feel being organized, with the list helped keep the situation calm and not confrontational. My Doctor during the time frame of the errors, had some problems dealing with the new computer charge system.
As to your question if I would tolerate the behavior you describe, it would be difficult. You say your treatment with him has been beneficial. Which could make it even a more difficult decision. I like options. Even if I did end up staying with him, I would find other pulmonologists in the area taking new patients. Leaving a Doctor who's treatments I felt were better than others would be difficult. Although, he resolved some of the financial issues, there wasn't follow through with the phone call. I would have niggling thoughts after he told me he has had patients leave because of problems. Eventually, it would just come down to how much patience I had with the situation.
At times I have had to resort to letters with copies of inaccurate bills because my Dr. just says talk to my office manager. Who I have talked to the office and her at least 5+x. This often resolves the problem.
Hope something here helps, K
Hi kgflibby, and thanks so much for sharing your own personal experiences dealing with your physician and the office business issues. The details you provided are certainly helpful to read! They seem remarkably (but not surprisingly), similar to the way I have been managing these sorts of occurrences - clearly they do work (but generally only with effort on our part!). From my perspective, it is worth it since I enjoy the care from these physicians. I look at the efforts made to reconcile all this as part of having these (often excellent) physicians provide care. The business end, as you pointed out, can often be resolved with the office manager or, even the billing manager.
I do hopehas a chance to look over our replies. Perhaps the information we have shared will be helpful for him/her.
As always, thanks for your input and experience - your feedback is appreciated.
Warmly,
Leon (site moderator asthma.net)and kgflibby, thank you so much for your feedback, I really appreciate it! I went to my doctor first with my challenges, as I really wasn't sure he knew what was going on in his office....he didn't. But you are right, I should call the main office and talk to the billing person to try and rectify the latest challenge. Hopefully that will work and I can keep my doctor (hopefully!). Thanks again, you've helped me see things more clearly. All the best, sm
Hi again, sm, - glad to hear thatand my responses were helpful for you. I think you've got a practical approach now, speaking with the main office/billing person. I usually do whatever I can to stick with the physician whose care I enjoy and value. I make the business end of the practice, their responsibility to straighten out after all, it is their responsibility! And, especially since you seem to appreciate this doctor's care of your medical conditions, that may be the way for you to go.
Please do check back and let us know how this all turns out for you.
Good luck!
Leon (site moderator asthma.net)
