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When the Doctor Charges for Unnecessary Tests

A story from our week along with some lessons we drew from it:

Part 1, February: After his primary care physican moved unexpectedly, Micah went to a new doctor to get a maintenance prescription refill. Upon arriving, he was told to pee in a cup. “Might this be a drug test to double-check that the prescription history I provided was correct?” wondered Micah. Doctor seemed distracted, constantly coming in and out. At one point, he said Micah should be given a strep test, and left. His assistant, also a doctor, came in looking confused and saying, “He wants me to give you a strep test?”

This assistant doctor had been in the room the whole time the doctor had been there and didn’t seem to find the test consistent with the visit. Besides, Micah wasn’t there for a physical check-up or sick visit in the first place. The doctor just needed another excuse to leave the room to talk to some people who had showed up. The assistant doctor swabbed the back of his throat, did something with the swab, and reported that the test said he was negative. The assistant doctor said something along the lines of “We already knew that” and left.

Micah wasn’t given the option of not having the strep test done. It was an order given by the doctor to his assistant. Micah was not informed that he would be charged for it. The doctor then wrote him a prescription for an allergy medication (whose name shared a couple of vowel sounds with the anti-depressant Micah was seeing him about) and gave him two samples of the allergy medicine. Micah assumed that the doctor knew what he was doing, and therefore didn’t notice that the prescription and samples were wrong until he got home.

Micah got the things straightened out the next day and resolved never to visit this doctor again.

Part 2, September: Seven months pass. We receive a letter from the doctor’s office letting us know that while the insurance company covered the appointment in full, they only paid about 2/3 for the strep test and the urinalysis. The office is billing us $22.50, or thereabouts, for the strep test and $2.80 for the urinalysis.

Micah goes to the office with a plan. Offer to pay for the rest of the urinalysis–which might have had some medical significance–but tell them he won’t pay for the strep test. The test was the doctor’s way of keeping him busy, they get paid 2/3 of the bill for it paid anyway.

His plan has a second stage if they insist on the strep copayment–to politely tell them that he won’t pay the bill and that he’d be contacting the insurance company as well as the state’s medical board with an official letter detailing the appointment and the doctor’s use of irrelevant tests as a way of keeping patients occupied. It’s certainly something the insurance company should know about and the medical board might consider it unethical. No arguing, no yelling, just polite information with a suggestion that they inform the doctor.

Fortunately, the office accepts his offer without any need for the backup plan. They say that they’ll put a note in his medical chart and accept the $2.80.

Micah had already resolved never to visit that doctor again, this bill was just confirmation that he was correct in his decision.

Lessons We Drew From This Experience

1) Challenge BS tests. Micah’s a non-confrontational guy and not a doctor. Though he was pretty sure the tests were BS to keep him occupied while the doctor went off to see some apparent friends who had decided to drop by the office, he believed that these would be covered under the insurance payment and might somehow be relevant since this was his first visit to this doctor.

Since now we’re aware that we may get charged in part for these tests, we’re both more inclined to challenge anything that looks like BS filler. It’s probably jacking up the cost of health care in America and we certainly don’t want to receive bills for it later.

There’s nothing wrong with asking your doctor “Why do I need this test?” You don’t have to be confrontational, just ask for information before proceeding. If you’re there about antidepressants and he wants to give you a strep test, challenge. It’ll save you the rest of the trouble.

2) If Charged, Make an Offer. Micah thought the urinalysis was probably BS too. But since it was only $2.50 and, unlike the strep test, wasn’t definitely irrelevant, he thought the gesture might make them consider accepting his refusal.

3) Bring Evidence to Support Your Argument. Micah brought along the detailed bill sent from the doctor’s office. It included the amounts the insurance company had alread paid which showed that that despite this test being unnecessary, the insurance company had paid 2/3 of it anyway.

4) Have a Backup Plan. It’s not illegal for a doctor to order unnecessary tests, even if his/her only goal is to keep your occupied, or if s/he is so distracted that s/he thinks you’re someone else. However, if these tests were ordered with no real medical purpose, it’s wasting the insurance company’s money. It’s also unethical to order these tests and charge the patient and their insurance for them. If they don’t remove the charge, follow through.

Both the insurance company and the state medical board will probably be interested in this information–the board for ethical reasons and the insurance company because they don’t want to be paying for even part of BS tests. Letting your doctor know you’ll be contacting them doesn’t mean yelling or arguing or even threatening. It’s a way of letting them know that you’re serious and also providing documentation of your refusal to pay and your reasons for doing so.

This documentation could come in handy later on if the doctor turns your account over to collections.

{ 11 comments… read them below or add one }

Bellen October 14, 2009 at 8:23 am

When you visit a doctor, any doctor, for whatever reason – DO NOT submit to a test, ANY test, until you know why. Question authority – Doctors are not gods, they are humans who make mistakes. A good doctor will take the time to answer your questions and provide reasons for asking for the tests. If the doctor does not – LEAVE. You are hiring the doctor, he works for you.

Jesse October 14, 2009 at 1:58 pm

I really wish I had gotten into the habit of researching things like medical practices before I had my first and only (knock on wood) medical emergency in my life so far.

I had Vertigo in January. It hit me so hard, right as I was getting into bed. If you don’t know what Vertigo is, it’s an inner ear problem that basically causes dizziness for an undetermined amount of time. I was bed ridden for almost 2 months, gradually being able to sit up, stand and sort of walk.

Anyway, we went to the doctors at midnight. They said there was nothing they could do and they don’t even really know what causes Vertigo yet they gave me an IV with fluids and a prescription for something. It turns out the prescription was for Dramamine, an over the counter anti nausea drug, but the prescription version would be 4x more expensive…why they gave me that when they knew I didn’t have insurance? Why they made me stay in the hospital for several hours when they had already told me there was no real treatment?

I have no clue, but the total bill ended up being around $1000. I have so little faith in the medical system already and this just put me even further over the edge.
.-= Jesse´s last blog ..What Every Blogger and Freelancer Needs =-.

Rachelle October 14, 2009 at 2:34 pm

This is beyond me that this actually occurs. I knew our health care system was inefficient, but this is outright wrong. Good for Micah to challenge the BS.
.-= Rachelle´s last blog ..Living Situation (Part III) =-.

moneyfunk October 14, 2009 at 4:44 pm

This happens all the time.
Thank you for writing a post and getting the thought out there! It is imperative to check your forms. Unfortunately, many people do not check or do not understand the coded list of things done.
And sometimes, it is hard to disprove many tests that didn’t take place or the med asst will explain that it was ‘protocol’ tests even if they didn’t take place.

I am glad Micah stood up for his beliefs. One step closer to people’s medical rights! 🙂
.-= moneyfunk´s last blog ..Have a Frugal Halloween =-.

Credit Card Chaser October 14, 2009 at 8:13 pm

@ Bellen

I agree with you that one should not be afraid to ask questions and that a good Dr should be prepared to give a good answer but at some point it is certainly a good thing to do to just trust the Doctor’s expertise (especially in this case where it is obviously better to have to undergo too many tests than not enough!)
.-= Credit Card Chaser´s last blog ..CBS News: Credit Card Companies are like “Legalized Drug Dealers” =-.

FinanciallySmart October 15, 2009 at 9:38 pm

It is always good to ask your doctor questions. In doing this one will be able to ascertain if some of the tests are necessary. It is good that Micah stood up for his right because the doctor behalf in an unethical manner. Thank you for highlighting this fact.

Mrs. Accountability October 16, 2009 at 5:25 pm

I was at my PCP’s office last to get a referral for my asthma specialist, who wants to see my twice a year. He needs to see me in order to fill my prescription, and the PCP won’t give me a referral unless I go to her office in person. My current primary care physician, who I will not go back to again, ridiculed me in a sing-song voice saying “Someone’s been on the Internet” when I questioned why I had to have all the tests she was telling me to get. She even said I had to go have a colonoscopy done, and those aren’t recommended until a person turns 50. I was only 44 when she said I had to have the test done. I did find another doctor that seems better, I just need to get switched over to her office.
.-= Mrs. Accountability´s last blog ..Guest Post: Managing Your Finances in Changing Times =-.

Allison October 16, 2009 at 11:33 pm

I’ve asked straight up whether a test was going to cost ME extra money/was covered by insurance (e.g. a test to determine the length of my eyes to see whether I was a good candidate for Lasik–when I wasn’t sure I wanted eye surgery yet). That saved me from having to pay for the test, which I would have needed a referral from my PCP for!

MLR October 22, 2009 at 10:56 pm

Using the fact that the doctor was acting unethically as a way to get the charges knocked off is, in my opinion, acting unethically.

Unless I am missing something, it was pretty much a blackmail? He could take off the charges and nothing happens, or charge you and have to deal with you contacting the insurance company and medical board?

I would have sent the documents and dealt with the charge separately. Think about how many people could have benefited from that if it changed his modus operandi!
.-= MLR´s last blog ..Top 10 College Degrees by Demand in 2009 =-.

mrsmicah October 23, 2009 at 7:06 am

@MLR The second was a backup, not the main strategy, a threat in case they first threatened to send our bill to collections and only going to be deployed in such a case. It would have been to let them know that just sending the bill to collections or continuing to charge us would not solve the issue.

Sometimes when dealing with unethical people trying to take your money, you have to let them know that you have some kind of power too or that you’re not going to just give in–they have the power to sic a collections agent on you and you have the power to report their unethical behavior. IMO that’s not unethical. Unethical would be to say “since you did this during the visit, I want my copay back or I’ll go to the state medical board.” Unethical is trying to get something that you DO owe them back. Telling them that you’re not going to stop fighting even if you don’t win today isn’t unethical. It lets them know that you’re aware of your other options and that if they don’t stop charging you today, it’s not just going to go away.

It’s like telling a neighbor to give you your deck furniture back or you’re going to call the police. Would you consider that blackmail? Is it worth getting the police involved if the neighbor gives everything back? (in this case, it may be prudent to do something if you think they keep stealing other people’s deck furniture).

Since he succeeded with the first, appeasing option–pay a small portion of the unnecessary charge–he didn’t end up needing to threaten anything. He may send the letter, who knows.

MLR October 25, 2009 at 10:02 pm

My main point was that you think the doctor acted unethically. However, you had no intention to report that unethical behavior, only to use it as way to get your money back.

You are pretty much enabling him to continue his unethical behavior for a small charge (refunding what Micah paid).

So yes, if I thought my neighbor would continue to steal other peoples furniture, I would call the cops regardless of whether or not he returned mine.

I just hope Micah does the right thing and reports him anyways!
.-= MLR´s last blog ..Top 10 College Degrees by Demand in 2009 =-.

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