Expert: Regan Shinski - 5/2/2010

Question
This winter I was diagnosed with Lyme disease, and since no one in Vermont is a Lyme specialist, I had to go out of network to find one.  The one I found said she was a Lyme Disease Specialist, but when I got to her office, she knew nothing about the disease, quoted vague, bogus studies, did not have any treatment recommendations and did not even know the size of the tick that carries Lyme. She ran a myriad of blood tests, and when they came back, I tried to contact both her and her nurse, but neither of them called me back. I finally had to find a different doctor, who was a real Lyme Disease Specialist, explained the disease, put me on a treatment protocol and basically healed me. I just got the bill for my visit to this first, supposed specialist, and it is 2500 dollars. Is there anything I can do about the bill? She works at a huge, very respected hospital.  I have never contested a bill before, and I have perfect credit history. Thank you!!!!!!

Answer
Hi Suzanne:

If it happened as you said, I believe you should contest the bill.  The procedures vary by state.  First thing is to send a formal certified letter to the hospital or billing agency disputing the services and bill.  Give them a few days or a week after they have received the letter and call to see if they have a response.  If they are unwilling to budge, file a complaint with the better business bureau and any other trade, medical, or governmental agency that they belong to or are licensed by.

It gets critical if they turn it over to a collection agency.  The collection agency will send you a letter that has some type of fine print in it about notifying them within 30 days.  It is CRITICAL you respond to the collection agency and hospital immediately upon receipt of this letter.  They cannot report it to your credit bureau within this 30 days.  Send a certified letter that you dispute the bill and ask for VALIDATION under the FDCPA.  At the same time send and urgent and certified letter to the hospital and hospital administrators/higher-ups.  Demand it be pulled from the collection agency and or dropped.  State that you will file a lawsuit within ten days to get it dismissed and that they will be responsible for you attorney and court costs plus statutory fines under the FCRA, FDCPA, and HIPAA.

Then it becomes a blinking game.  Do you want to pay, settle, or go ahead and fight if they don't blink?  If you believe you have a solid case, you can file a lawsuit collect money, dismiss the debt, and eventually get the collection removed from your credit (if it even gets put on there) but it may take several months and cost you some up front court and/or legal fees.  If you pay, you avoid everything and protect your credit, but are paying for unwarranted services.  Settling is somewhere inbetween.

Finally, some states have medical review boards or arbitration settings that handle situations like this.  These are a little more user friendly and may spell out additional options for you.  I encourage you to contact county and state governmental agencies that may have these services.  It will probably take several calls just to get a basic answer if they even exist in your state, but it may be worthwhile.

Good luck, I hope this information helps.

Regan