Expert: John Hall - 6/30/2006

Question
Late last year I was visiting in AZ when I ruptured 3 disks in my back and had all the residual problems associated with that including surgery, medication, and finally a procedure called an injection at one of the local outpatient surgery centers.

It was very complicated because my insurance was from CA and in CA it was called Healthnet yet when I am in AZ (or just out of state) it was to be billed under a separate name called First Health Providers.

To make a very long story short, every time I had a procedure or went in for an appt, I stated very clearly that my insurance was NOT healtnet -- I was ADAMENT about it because one of the hospitals when it all first started had billed it wrong and I almost ended up getting a bill for $20,000! Anyway, I was very clear. I had to be.

So my doctor's office set up an appt with an outpatient surgery center who quoted me a $250 co-pay for an injection. The office was told about my insurance (I overheard them being told on the phone as well did my own mother) when we were sitting in the office. Also, the outpatient center called me and interviewed me thoroughly before the procedure and I made it very clear once again that they needed to be very sure about my insurance and having it billed correctly.

On the day of the procedure when I went in and filled out the paperwork, I showed the girl at the front desk my insurance card (she made a copy) and clearly stated once again "Are you sure everything is correct and you are NOT billing me under Healthnet?" I had a witness with me (my mom's best friend who had driven me). I was as clear as could be with every single person I came into contact with during this entire episode. Time and time again I was assured that the insurance was fine and I was covered except for the $250 co-pay. When I checked in I paid the $250 and was told I was paid in full.

So flash forward about two months after the procedure and imagine my surprise when I got a bill in the mail for almost $1800! In addition to the $250 I had alread paid! Obviously I was upset but I just figured it was a mistake and could be rectified like my hospital bill had been. Well, I faxed their office (and called) and no one responded to me. I waited another month or so and faxed and mailed their office with a letter clearly stating everything from my point of view and my disappointment in the fact that they had even failed to respond. About a week later I got a certified letter from the billing office that was condescending and basically said GEE, SORRY, IF YOU HAD EXPLAINED YOUR SITUATION TO US WE MAY HAVE BEEN ABLE TO AVOID THIS but seeing as you didn't, you are responsible for this bill.

I was livid. Not only were they just condescending *******s in the letter, the fact that no one called me, no one said boo until I had to write to them twice and beg for answers and then they were telling me they had no idea about my insurance situation just about sent me over the edge.

The fact is, they did know. And someone in that office is covering someone else and I am the one who's going to end up getting the short end of the stick.

I wrote them again and countered what they said by the facts and I offered a moment by moment account and flatly said that I would have had to set myself on fire to be any clearer when I had explained to EVERYONE in their office what my insurance situation was.

So a month has gone by and today one of my friends who ended up renting my house in CA called and said she had received a bill for me today from the outpatient surgery center for the $1800 plus $92 in interest.

A) Why in the world would they send the bill to CA when they know I'm here in AZ and that's the address that has been used with all other correspondence.

B) I am just completely baffled that someone in their office is not at least trying to be understanding about this situation and give me the common courtesy of calling and talking with me or responding to my last letter.

I am just at a loss here. Do I have any recourse whatsoever in this situation? I have been wiped out with medical bills this year and while $1800 may not be a lot to some people, it's a lot to me -- especially when my co-pay for that surgey was only $250 had I been somewhere that the insurance was good. I feel like I did everything in my power to go through the right channels and protect myself and I still got screwed. It was an emergency situation and I was very ill when this was going on but even with that, I told anyone who would listen about being careful.

I can't afford to pay them and honestly, on principal alone I have a problem paying them. On the other hand, I've worked hard to have good credit for years and I don't want one screw up that wasn't even my fault to mar my good name and history.

Please, what should I or can I do in this situation?

Thank you for your help in advance!

Answer
When you get this respnse to your question at this service (allexperts.com), make a copy of both your question and this response and send it to the doctor that is responsible for the misrepresentations that were made to you.  Tell him (or her) that you have spoken with an attorney and that it has been suggested that you bring a lawsuit agaisnt them not only for a declaratory judgment that you don't have any obligation to pay under these circumstances, and further that due to either the negligence or intentional misconduct of the billing staff, the doctor's office is liable to you in money damages.  

If you don't get a favorable response real quick, call me back and I can help you further.    661  492-2673   Chances are that these people have been so sloppy and arrogant in their office procedures that they have been getting away with these, at best, negligent misrepresentations.  You have a good case against them here if they do not quickly resolve this situation.  You have several options you can use against both the doctors office and the people involved individually.