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.

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