Dr pulled a scam who can I make complaint too?

bhoges

bhoges

Sergeant
Full Member
Minuteman
Nov 11, 2003
917
170
Plainview,NY
#1
After getting a check up at a new doctor he asked whatever checks that come direct from the insurance company be forwarded to him. So two months after my blood tests I get a bill from the lab stating they bill was never paid. I assumed wrong that he would forward the checks to the labs. So this guy ended up getting paid 2x for the work. I have called several times with no answer from the office. Now when I by a chance Im going to stop by in person. Anyone who who I can file a complaint with? AMA? Im pissed this is over $600 in tests. Thanks
 
#3
Re: Dr pulled a scam who can I make complaint too?

In no particular order...your own insurance company...the State Medical Board (responsible for licensing/credentialing physicians)...any insurance fraud agency/entity within your state (such as the State Insurance Commission as one example)...the hospital (or other medical institution) with whom the physician is affiliated...local/county prosecuting attorney's office depending on how much money we are talking about here...the NY State attorney general's office...the list goes on and on.
 
#4
Re: Dr pulled a scam who can I make complaint too?

First of all make sure that your insurance even covered the services in question. This will be on your explanation of benefits sent to you by the insurance after the filing of the fees. Second make sure you understand at what percentage your insurance covered if in fact it did pay for the services. I know from personal experience that patients are most often confused about coverage and don't know their own benefits and isurance policies. If all that is squared away and you know something fishy was going on the best avenue first is your insurance company followed by a complaint to the state board of medical examiners (the state board has to investigate ANY complaint). It is unlikely the guy is trying to dupe you because insurance fraud is both a big deal and basically impossible to hide.....but hey, you never know. Like the general population, there are some shitty dishonest MD's out there.
 
#5
Re: Dr pulled a scam who can I make complaint too?

Thanks for the input. All it was were simple blood test. Thats why im confused to all the bills. I told him if anything is out of network I dont want it done. He tried to get me to do allergy tests last visit. Damn I went there because I was feeling tired and it turns out I was low on vitamin B. He is trying to test me for everything just to run up the bill I feel now.
 
#6
Re: Dr pulled a scam who can I make complaint too?

Nail his sorry cheating ass to the wall.
 
#8
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: ggmanning</div><div class="ubbcode-body">First of all make sure that your insurance even covered the services in question. This will be on your explanation of benefits sent to you by the insurance after the filing of the fees. Second make sure you understand at what percentage your insurance covered if in fact it did pay for the services. I know from personal experience that patients are most often confused about coverage and don't know their own benefits and isurance policies. If all that is squared away and you know something fishy was going on the best avenue first is your insurance company followed by a complaint to the state board of medical examiners (the state board has to investigate ANY complaint). It is unlikely the guy is trying to dupe you because insurance fraud is both a big deal and basically impossible to hide.....but hey, you never know. Like the general population, there are some shitty dishonest MD's out there. </div></div>

If you read the fine print of most patient contracts, you agree to pay fees when then insurance companies don't. Do you know what happens when a doctors office calls an insurance company to verify benefits (please call your provider line of your insurance card to verify this if you don't believe me): The very first thing the insurance company reports is "Pre-verification of benefits is NOT guarantee of payment"...your doctor ordered tests trying to help you, and you expect him to pay because your insurance won't?? You know how many claims insurance companies don't pay that they should? It used to be around 30%, but know its getting close to 70%; trust me if you knew the overhead of the doctors office you wouldn't be bitchin'...The winner here are the CEO's of the insurance companies and their shareholders rolling in dough..;along with big Pharma...but go ahead, crucify your doc without getting to the bottom line...
Now, say you called your insurance, and they did pay (or lets just say you do have a legitimate complaint with your doctor's office)...the place to file a complaint is going to be your state's Board of Medicine. All doctors offices have to legally post it in their office, but you can just go online, type in: (State) Board of Medicine, Patient Complaints...and go from there...some states also have Insurance Boards which is worthwhile as well if this is an insurance issue, which I think it is...
 
#10
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Brian</div><div class="ubbcode-body">Thanks for the input. All it was were simple blood test. Thats why im confused to all the bills. I told him if anything is out of network I dont want it done. He tried to get me to do allergy tests last visit. Damn I went there because I was feeling tired and it turns out I was low on vitamin B. He is trying to test me for everything just to run up the bill I feel now. </div></div>


No offense man, but if you don't want a Dr. with 13ish years of formal education/medical training and however many years in his practice making medical decisions on which tests you need run in order to have your problem resolved.....head over to walgreens or CVS, close your eyes and pick something off of the shelf....
 
#11
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: CypressJeff</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Brian</div><div class="ubbcode-body">Thanks for the input. All it was were simple blood test. Thats why im confused to all the bills. I told him if anything is out of network I dont want it done. He tried to get me to do allergy tests last visit. Damn I went there because I was feeling tired and it turns out I was low on vitamin B. He is trying to test me for everything just to run up the bill I feel now. </div></div>


No offense man, but if you don't want a Dr. with 13ish years of formal education/medical training and however many years in his practice making medical decisions on which tests you need run in order to have your problem resolved.....head over to walgreens or CVS, close your eyes and pick something off of the shelf....
</div></div>

Right because obviously anyone with all that education/training/experience would never do anything scandalous. That's like accusing an Attorney of over-billing hours, or having an Accountant embezzle their clients money.
 
#12
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Broker</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: CypressJeff</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Brian</div><div class="ubbcode-body">Thanks for the input. All it was were simple blood test. Thats why im confused to all the bills. I told him if anything is out of network I dont want it done. He tried to get me to do allergy tests last visit. Damn I went there because I was feeling tired and it turns out I was low on vitamin B. He is trying to test me for everything just to run up the bill I feel now. </div></div>


No offense man, but if you don't want a Dr. with 13ish years of formal education/medical training and however many years in his practice making medical decisions on which tests you need run in order to have your problem resolved.....head over to walgreens or CVS, close your eyes and pick something off of the shelf....
</div></div>

Right because obviously anyone with all that education/training/experience would never do anything scandalous. That's like accusing an Attorney of over-billing hours, or having an Accountant embezzle their clients money. </div></div>



No, Because I am in the medical field as well and I see where he is going with the test. The sky is not falling and nobody is out to get you. If you want to be the Dr then go to Walgreens. If you want someone else to be the Dr, then go to a Dr. It's pretty simple.
 
#13
Re: Dr pulled a scam who can I make complaint too?



At the same time, you shouldn't go to a Dr that you don't trust. So, maybe it's time you find another Dr. What I'm saying, and maybe I said it the wrong way, is don't discount the testing process.
 
#15
Re: Dr pulled a scam who can I make complaint too?

If the physician indeed screwed you over then he did it with the subtlety of a baboon. I am thinking this is not the case. However, if he is really screwing you over this is not his first time. A notable study showed than an overwhelming percentage of medical students with punishments/infractions will have similar character/ethical/legal issues in practice and vice versa. My medical school has been pounding this into our heads and any serious infraction of rules results in dismissal because of the study.
 
#16
Re: Dr pulled a scam who can I make complaint too?

I've seen and paid an awful lot of medical bills in my lifetime. If I had 1% of that money, I'd have been able to obtain several times as many guns as I gave today.

For starters, figure two year-long bouts with Lymphoma, a coronary involving cardiogenic shock, quad bypass, pacemaker/defib implantation, and a three week rehospitalization in the CICU for postop infection. Quite a bit of it was not covered under insurance, to a tune well into six figures.

For a second helping, my Wife was once in ICU/Coma for several weeks, and required lengthy rehab.

I do not currently owe for any medical bills. Not fun, but it's done.

Most Doctors don't process their practice's medical finances personally. They operate offices and have staffs.

When I had a question about coverage claims and payments, I took it up with the insurer/payer. It's their money that's being used or misused, and they at least have a stake in the propriety involved.

They would be my first call. I would not be dictating terms, I'd be asking questions.

They can usually take it from there. If they tell me I have to pay, I'm not taking them on in addition; I pay.

Greg
 
#18
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: ggmanning</div><div class="ubbcode-body">I think you quoted the wrong guy here UKD. I am a doctor and you are preaching to the choir. </div></div>

No I meant to do a +1... or a This ^^^^
 
#19
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Jig Stick</div><div class="ubbcode-body">The insurance company is where I would start. They hate fraud </div></div>

LMAO They ARE the fraud...
 
#20
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: UKDslayer</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Jig Stick</div><div class="ubbcode-body">The insurance company is where I would start. They hate fraud </div></div>

LMAO They ARE the fraud... </div></div>

100% True! They lie,cheat and steal with Impunity.
 
#21
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: MAGUA</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: UKDslayer</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Jig Stick</div><div class="ubbcode-body">The insurance company is where I would start. They hate fraud </div></div>

LMAO They ARE the fraud... </div></div>

100% True! They lie,cheat and steal with Impunity. </div></div>

Not all of them. When I was living in Texas and had homeowners with Beacon Insurance, my home was robbed. Beacon was more than fair with me and I received a good, prompt settlement. I had a PRS guitar that I paid $1600 for at least 15 years before and their research showed that as a collector item it was worth $3800 so thats what they paid me. Thank you Beacon.
 
#23
Re: Dr pulled a scam who can I make complaint too?

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: UKDslayer</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: ggmanning</div><div class="ubbcode-body">I think you quoted the wrong guy here UKD. I am a doctor and you are preaching to the choir. </div></div>

No I meant to do a +1... or a This ^^^^ </div></div>

Ahhhh I see. Should have made known that with the context of your post. You are completely correct that unsurance companies are the fraud. The general population has been brainwashed into thinking that if insurance doesn't cover a procedure then it was unwarranted. In reality insurance often fights me over payment of the basic protocol procedures....even those needed for the safety of a patient. Their main interest is making money and they could care less if you the patient is hurt in the process, and that is the truth plain and simple. On the other hand if don't order a test or do a procedure because insurance won't cover it and anything at all happens guess who rolls in then???? Malpractice attornies.
 
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