Doctor Charging $6,000 per Hour

[theroot]

My question involves collection proceedings in the State of: ohio

Hello, there's probably several fascets to this case, and I dont know what direction to take. I've taked to 3 local lawfirms here and they dismiss me within a minute of trying to explain the situation.. Cannot seem to find good help now a days.

A few months ago my wife passed out at a bar and fell down and broke her jaw in 3 places and 20some teeth. They rushed her to the ER because she loss consciousness again and obviously had a broken jaw. She had to have immediate surgery that evening in the OR to get her bones reset, a plate put in, and her jaw wired shut. This was done at an in network hospital (biggest hospital in this city) through my insurer (Anthem). My policy is pretty simple, i pay 7,000$/yr deductible, they pay 100% of all in-network charges after that.

So the hospital bill for 4 days and all related work came out to 50,000$ and I paid my 7000 to various people.. A couple months later I get a bill from the surgeon that performed the jaw reset and wirring shut. Apparently he's not an "in-network" surgeon. Even though I was at an in-network hospital, he didn't tell me before he did the surgery he wasnt in-network, and certainly didn't tell me what he was going to charge.. His bill is 18,000$ for the procedure. Now that doesn't include materials, the metal, the other surgeons in the room, the anesthesiologist, the room itself, all other charges were seperate on the main hospital bill. This bill is simply for his time in the room. He didn't remove any teeth (he left them in there, like a a**), he didnt do anything else. I know when he arrived at the hospital because we were waiting in the OR prep room for him, and i know when he came out and said we're done, he was there working for no more then 3-3.5hours. That means he's charging almost 6,000$/hr for this work!

I go to my insurance company and ask them to pay on this bill because i was at an in-network hospital, it was an emergency, i had no option of surgeons, at a in-network hospital. They come back and say we'll agree to pay the surgeon what we wouldve paid any of our in-network surgeons for the same procedure - which is 1,800$. Which sounds a bit low, but still not bad, 600$/hr. i'm sure is a decent rate for a maxiofacial surgeon. However it's 1/10th what this guy is trying to charge me. He is unwilling to drop the price at all, unwilling to negotiate down at all (and certainly not down to 16,000$ less then what hes charging). He's already sent it into collections because I told him I couldn't pay it. I don't even want to pay him 1$ a month, he is screwing us over blind.

There has to be some legal protection right? A doctor cannot just charge whatever he wants, cannot charge 10x more then what the procedure should be, and cannot disclose that kind of information up front, right?? I figured there has to be something i can do legally to fight this? Whats to stop the doctor from charging me 100,000$/hr if he can charge me 6,000$/hr. What kind of lawyer do i need to talk to? All the medical and insurance lawyers ive spoken to were useless, and said they couldnt help me.

I fear if i dont pay on this in the next month or so i'm going to get sued. And my only other option is bankruptcy, considering i depleted my savings paying off the rest of the bills from this accident.

Please help with any advise!

Thanks!

[jk]

A doctor cannot just charge whatever he wants, cannot charge 10x more then what the procedure should be, and cannot disclose that kind of information up front, right??

not right.

I fear if i dont pay on this in the next month or so i'm going to get sued.

You could be right.

And my only other option is bankruptcy, considering i depleted my savings paying off the rest of the bills from this accident.

So I guess you should be looking for a BK attorney.


While I agree that it should not work this way, the fact is; it does. Sorry to say but given this in network and not in network stuff with the insurance company, you actually have to verify such issues as they come along. Your insurance company is only obligated to pay whatever your policy says they have to pay. If you believe they have paid everything they are contractually required to, then of course, you have no complaint with them and are left with what the doctor demands.

Whats to stop the doctor from charging me 100,000$/hr if he can charge me 6,000$/hr.

Realistically? nothing.

[cbg]

Just as an FYI:

It is entirely possible for the ABC Health Insurance Carrier to have multiple networks, with some doctors being on some but not all. If ABC Health Insurance has one network for HMO's, one for POS's and one for PPO's, some doctors might be covered on only the PPO network or on the HMO network, or just on the PPO and POS but not on the HMO. They'll be on the plans that make the most economic sense for them, and that does not always mean every network offered by a carrier.

No insurance carrier, and no hospital, can force every doctor working there to participate in every insurance carrier that the hospital is in, except in very limited staff-model HMO's. Believe me, they would if they could. But we outlawed slavery quite some years ago and the doctor has the right to decline to participate.

But the point I am getting at is this: First, the doctor does not know who your insurance carrier is. His billing office may, but he does not. And his billing office isn't there in the ER with you. And even the billing office, let alone the doctor, doesn't know off the top of their heads which network you're covered under and whether the doctor is in or out of network for the specific plan you're on. I've listed three possibilities above, but the same carrier could have a dozen or more networks, with different doctors on each one.

It is not the doctor's responsibility to tell you that he is not in network for your plan. It is your responsibility to confirm your information with the ER and ask them, to the best of their ability, to see that you are assigned to doctors that are in network for you.

Just for future reference, some of the most notorious specialities for NOT joining managed care networks are radiologists, anesthesiologists, and ER physicians. They have more or less a captive audience and can make more money by NOT joining networks. If a hospital granted privileges ONLY doctors who would sign up with all the hospitals networks, they'd have very few doctors available in those areas.

[Mr. Knowitall]

I expect that the doctor isn't billing by the hour. I expect that he's billing by the service, probably according to a diagnostic code or set of codes. If you have his bill you can try to investigate any listed codes to see if the bill makes sense - is he, for example, billing for overlapping services that really should fall under a single code. Your insurance company has seen his bill, so they may be able to help you understand it - although they're not obligated to do so, so if you try to get them to explain the bill to you be sure to ask nicely.

Your insurance company would be paying some discounted rate based upon the prevailing rate - so if we are to assume that it might pay $1,800 for the procedure, the prevailing rate is probably in the $2,400 to $3,000 range. Your insurance company may be willing to give you that information; they have it, but I can't promise they'll share it. Still, if this guy isn't going to settle for a penny less than $18,000, that's not going to resolve the problem.

Many hospitals offer ombudsman services to help patients deal with billing issues. You can check with the hospital to see if they impose any contractual limits on the rates their doctors charge, or if they can help try to resolve a billing issue with this doctor.

The BBB will generally take complaints about billing disputes with doctors. They can't do much more than ask the doctor or hospital to respond and make a report; but some doctors and hospitals won't want a negative report out there so... it might help. Small chance, though - I would try the other stuff first.

[theroot]

I expect that the doctor isn't billing by the hour. I expect that he's billing by the service, probably according to a diagnostic code or set of codes. If you have his bill you can try to investigate any listed codes to see if the bill makes sense - is he, for example, billing for overlapping services that really should fall under a single code. Your insurance company has seen his bill, so they may be able to help you understand it - although they're not obligated to do so, so if you try to get them to explain the bill to you be sure to ask nicely.

Your insurance company would be paying some discounted rate based upon the prevailing rate - so if we are to assume that it might pay $1,800 for the procedure, the prevailing rate is probably in the $2,400 to $3,000 range. Your insurance company may be willing to give you that information; they have it, but I can't promise they'll share it. Still, if this guy isn't going to settle for a penny less than $18,000, that's not going to resolve the problem.

Many hospitals offer ombudsman services to help patients deal with billing issues. You can check with the hospital to see if they impose any contractual limits on the rates their doctors charge, or if they can help try to resolve a billing issue with this doctor.

The BBB will generally take complaints about billing disputes with doctors. They can't do much more than ask the doctor or hospital to respond and make a report; but some doctors and hospitals won't want a negative report out there so... it might help. Small chance, though - I would try the other stuff first.

Thanks for the response. Yeah I mean even if the prevailing rate is 3k or 4k, id be willing to settle for that. He wasn't willing to knock it down at all though. I'll talk to the hospital about it, but i make too much to apply for any kind of financial assistance from them (pretty much screwed if you make over 20k/yr w/ a wife and one kid). Even though i'm self employed and its private insurance :-/ and my wife isnt employed at all.

What do other people do with instantly 25k$ in bills that they have to pay or get sued? Even if i pay 100$/month on it i'd have it paid off in 15 years (assuming theres no interest). And most of my previous debt payment plans required it paid off within a year.

The BBB - just looked him up - he had one negative complaint where he screwed someone over 200$ and he responded to the claim but refused to take it out of collections. So I don't think he'd care if i do that.

Still looking for ways I can drop his bill to something more fair. If the insurance company says the prevailing rate is 3,000$ and i call around and talk to other surgeons for the same codes and time spent they say 3-4k between 10 other local surgeons - and no one says over 4,000$. Would that not help in some sort of case against him? He's clearly taking abuse of the situation, he knows it was an ER, knows i had no choice in options, knows we didnt agree on a price before (i didnt even meet him before), etc etc. It's abuse and gross overcharging. IDK. Just surprised out of all the BS laws out there, there might not be anything that actually helps me on this.

[mmmagique]

If the hospital won't work with ya, I'd bk so fast the surgeon's head would spin. (I've never bk'd but this is a prime example of why we do have bk laws.) Good luck.

[theroot]

If the hospital won't work with ya, I'd bk so fast the surgeon's head would spin. (I've never bk'd but this is a prime example of why we do have bk laws.) Good luck.

Yeah, I think BK is an alright option. I haven't really researched it well enough to fully qualify that statement. IE i don't know what itd cost, i dont know how easy it would be for my wife to go BK married to me and a decent source of income, if id be resolved of all that debt, etc etc. My wife really hates the idea though, and hates the idea of it on her perfect credit for the next 10 years. Shes is also unable to work/pay on any her debt herself, so its a difficult argument lol..

Maybe I'll talk to a credit/bk lawyer spefically maybe they can give me some guidance. Since the medical ones i've talked didnt seem to think they could help in this situation. Although im still shocked/appalled by that.

Thanks!

[tc498]

The charity program has guide lines but maybe if you can find the right person,you talk one on one,explain how even people with good jobs don't just have 16,000 sitting around. If he sends it to collections the collection agency will probably settle for less then 16k b.c they buy the debt for cheap. The collection agency is gonna call before filing a lawsuit,I would talk to a lawyer or credit consuling once the collection shows up on your credit report. Idk how it works but since it's medical you might have some legal rights.

Talk to a few bankruptcy lawyers ,maybe you can solve this some other way then just filing bankruptcy.


Try posting this on http://creditboards.com/forums/index.php?showforum=2

The site also has a lot of good information.

[mmmagique]

But if you can't pay the bills, her credit won't be perfect for a long time anyway. This is a nice clean cut as opposed to a long, slowww, protracted, drawn out debt pit. *lol* (I'm just kidding, but I'm sure you get the idea.)