Hey gents, anyone ever gotten wildly over billed by a doctor and been able to deal with it? My wife ended up in the ER a month ago when she cut a nice slice into her finger chopping veggies. We paid all the ER and hospital bills and insurance paid the actual guy who stitched her up $2700 for the 5 stitches. Now the guy who stitched her has sent us a -- wait for it -- $23,000 bill for his services - money he wants on top of the $2700 he got from insurance. As ever, refusal to pay means he'll report it to our credit filing agencies.

Anyone have ideas for how to handle this. I'm thinking I might talk to some friends in news here in NY and do a story on him and overbilling in medicine (a good story, actually) but I need to deal with the bill itself somehow.

Wow. I've had cases where I was billed for stuff that didn't happen (they took it off the bill when I pointed it out). But never egregious over-billing like that. I'd talk with your insurance company for one and the hospital as well.

- Oh, and there is the new consumer protection bureau that may be able to help.

Definitely do some more research...between what you payed at the hospital and what your insurance covered should have been well more than enough for 5 damn stitches. Hell, I could have done them for you for free. (Yes, was a medic for 10 years and trained to stitch by 2 general surgeons and 1 plastic surgeon. My work, when I did it, left very tiny scars...) I think this idiot is attempting to fleece you...

Seems like balance billing legality differs state to state, but in ER situations I believe it's now illegal in CA (not sure if you live here).
Maybe this link will help you?
https://www.americanbar.org/newsletter/ ... e/Lai.html

If this is happening in NY this might help, pg. 18
http://www.governor.ny.gov/assets/docum ... Report.pdf

Best of luck!

Its happening in NYC. The research I've done tells me the average price should be about $1800. After getting $2700 from insurance I still would have PAID the guy $1800 had he billed me (he did nice work). But now it's 'a thing' I'll use the consumer protection department and a few other obvious things. My real hope is that between the investigative producer from 60 Minutes that I know and the girl at NBC NY that does 'consumer protection' stories, I can hand this guy his ass long before I pay to worry about the actual bill.

I'll keep you posted.

contact your insurance company to find out what the Hospital sent over, and let them know about it as they should be able to follow up on it, beyond that the only thing I can think of would be a situation where it was done out of network

Just in case it hasn't happened yet, have you called the doctor's office to confirm the bill? When I took care of all my dad's stuff I'd get all kinds of crazy bills in the mail but when I called the doctor's office they told me it wasn't actually a bill and I shouldn't worry about it.

Oh and off-topic a little, even with insurance my pops ended up paying over $80k out of pocket that year. I love reminding people of that every chance I get, what a travesty our health-care system is.

If you already confirmed that he's really billing you for that much then I hope you ream him a real good one in the public arena AC.

holy sweet baby Jesus! I had leg surgery and only had to fork out a couple grand. Insurance covered the rest. Shouldn't your annual "out of pocket maximum" kick in? $23,000 is absurd.

http://cnn.com/video/data/2.0/video/us/2013/02/21/ac-kth-griffin-hidden-hospital-bill-costs.cnn.html

There's an article at Time magazine, but I'm not a subscriber. Somewhere in the middle of the video, they talk to a medical billing advocate who works out of (I think) Roanoke, VA. Might be worth contacting.

Update: NBC news NY is coming out to do a story on the inflated billing. The doctor started calling on Thursday to see if we could 'resolve' the bill but we haven't called him back yet. Still pondering our options.

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It's good to have friends.

Can't wait to see how this one turns out.

A link to the story would be appreciated as well...also, I would call the guy back and let him know that what the insurance paid him is what was allowed. Any and ALL overcharges will just have to be investigated and highlighted in the news. He wants to 'resolve' so his name is not brought up and his greed brought to light. Only resolution I would be open to would be a COMPLETE nullification of the overcharge.

Sic'em AC!

Good luck and let us know how it goes! It would be interesting if they find that he's done it to a lot of other folks...

here's the bill, by the way

WOW...I wonder if I can collect back pay from all of the people I stitched up over my years as an AF Medic.
Fry this guy A/C...this is ridiculous in the extreme.

I think we found the solution to the healthcare costs in this country, just fire that guy. geez!

I think what is bothering me most isn't that he did it to AC and family (sorry) but that this guy's probably also done it to others that don't know their rights, how to appeal, work with their insurance carrier, or fight back through the media. AC has a voice and isn't afraid to use it - so I'm not worried that he's gonna get snookered, but how many other people have paid much or all of these obviously inflated bills, to their detriment?

Agreed Tien, I was thinking much the same thing. At the very least, perhaps the doctor in question will be on the hook to repay all the people he screwed over.

While outrageous and no doubt a potential PR nightmare, I'm not sure why you all think what he did was illegal in our system and so require any sort of restitution.

It appears, from some input I got, that he did - in fact - commit fraud (though it'd be hard to get a judgment). The codes he used were for critical and severe cases that require significant work that he never had to do. Up-coding is medical fraud, though then we're talking about court and getting one doctor to argue what was and wasn't necessary while he argues that it was. Hard to get a ruling.

I see, maybe he was expecting to get more from the insurance company. I'm not sure what coding has to do with billing individuals.

lmao oh i love this so much AC, hey he's getting a free colonoscopy out of all this so he should be grateful

coding is complicated - there are two kinds of codes on this bill (and on all bills) a diagnostics code, saying what the problem is and then a set of procedural codes saying how it was fixed.

generally, you can't unbundle your codes and bill them separately. for example, you can't bill for both exploring the would and suturing it - because suturing it requires exploring it - the act of exploring is covered in the cost of sutures. if you don't need to stitch it, you bill for the exploration that determined that. he billed for both and added the 'modifier' saying that the wound included multiple cuts so he actually had to do BOTH things as separate procedures and needs to be paid for both. this is untrue, there's only a single cut involved so that could be pursued as fraud.

the code 99284for the ER visit includes a 'severity' index. the last digit (4) is on a scale of 1-5 regarding how serious the injury was. 4 is very extreme and requires the execution and documentation of 12 different aspect of the wound and medical history. if those 12 steps don't appear in her chart (which we've requested from the hospital) then he has upcoded the severity in order to bill at a higher right - which is also fraud.

as someone who gets upset that we have to pay $104 if we take an ambulance, I'm sickened by this AC. Something jumps out at me... can you get a copy of the bill that the insurance paid on your behalf? I'm sure there's no way he gamed the insurance company and by comparing the two you should be able to catch him out on it... and when you do catch him I'm sure you can sue his pants off for stress and damages this has caused you and your family. I mean that person won a bunch of $$$ for the hot coffee from McDonald's, so...
Is your insurance through your work at the network? If so, you should be able to approach the big whig studio lawyers to represent you, no? You could come way out on top of this.
Love and luck,
Zero.