Time traveling doctor's office went back in time one day to give me a physical I didn't have, and then billed my insurance for it

[zealanddonk]

What exactly takes place when you guys get a physical?

Blood pressure taken, body temp checked, lungs listened to, weight checked, heart listened to, pulse taken, reflexes checked, EKG test (since I turned 40), prostate checked (since I turned 39), blood drawn and labs taken, urine sample taken and labs, eyes looked at, ears looked into, sinuses checked, lymph nodes checked, flexibility checked...

So Druf fis upset he didn't get a finger in the arse?

Also, fairly sure I know why Druff has high blood pressure.

[LarryLaffer]

Blood pressure taken, body temp checked, lungs listened to, weight checked, heart listened to, pulse taken, reflexes checked, EKG test (since I turned 40), prostate checked (since I turned 39), blood drawn and labs taken, urine sample taken and labs, eyes looked at, ears looked into, sinuses checked, lymph nodes checked, flexibility checked...

So Druf fis upset he didn't get a finger in the arse?

Also, fairly sure I know why Druff has high blood pressure.

to be fair, prostate cancer is one of the leading causes of death for men 40 ad over.

I guess i have 10 years until someone has to do that. maybe by then we'll have a different way

[HoodedN]

So Druf fis upset he didn't get a finger in the arse?

Also, fairly sure I know why Druff has high blood pressure.

to be fair, prostate cancer is one of the leading causes of death for men 40 ad over.

I guess i have 10 years until someone has to do that. maybe by then they'll be able to get the whole fist up there

[Dan Druff]

Update:

Operations manager did not call me. I called him at about 5, he was in a meeting, he called me back at about 5:30.

Started out with, "I did a cursory investigation, and you're not going to like what I have to say...."

Shit.

Basically he told me that I got a "valid physical", and they WILL be billing it as a physical. Told me that if I wanted, I could go back and they would complete it for me.

Fuck that. I already offered that yesterday, and I got a nasty response and literally hung up on.

I reiterated my very reasonable demands (see page 1), and basically told him that I was going to rain down the wrath of God on their company if they dared bill my insurance for a physical I did not want nor authorize.

After some back and forth, he said, "Let me do some more looking into it and talk to you on Monday."

This is such a joke. They can solve this by letting me have the fucking labs for free and backing out a $30 charge. It's not like I'm asking for a $5k settlement or something.

He seems to know everything I'm saying really happened.

Why can't he just end this?

[snake_in_the_ass]

Update:

Operations manager did not call me. I called him at about 5, he was in a meeting, he called me back at about 5:30.

Started out with, "I did a cursory investigation, and you're not going to like what I have to say...."

Shit.

Basically he told me that I got a "valid physical", and they WILL be billing it as a physical. Told me that if I wanted, I could go back and they would complete it for me.

Fuck that. I already offered that yesterday, and I got a nasty response and literally hung up on.

I reiterated my very reasonable demands (see page 1), and basically told him that I was going to rain down the wrath of God on their company if they dared bill my insurance for a physical I did not want nor authorize.

After some back and forth, he said, "Let me do some more looking into it and talk to you on Monday."

This is such a joke. They can solve this by letting me have the fucking labs for free and backing out a $30 charge. It's not like I'm asking for a $5k settlement or something.

He seems to know everything I'm saying really happened.

Why can't he just end this?

Looks like you are the one getting shitty service. I would rather take the sweatshop operation at Kaiser over what you are going through.

[big dick]

How much of your time have you spent on this druff? Ball park if you're not sure. Im just curious cus im curious

[Dan Druff]

How much of your time have you spent on this druff? Ball park if you're not sure. Im just curious cus im curious

On the dispute portion, I'd say I've wasted about 3 hours (not counting the posts here, which at least are entertaining for the readers).

But I'm not backing down on this one. Not letting them get away with robbing me of my physical and getting paid for it.

[big dick]

Fuck them I agree I was just curious.

[Dan Druff]

A few years ago I had another absurd medical billing situation, albeit not as bad as this one.

I needed an MRI, gave the facility my insurance card, they checked it out, and they had me sign a paper that I would still owe something like $770 on my MRI out of pocket according to my benefits. Basically they were trying to protect themselves from people who claim shock when their insurance doesn't cover what they expected. I knew this going in, so I willingly signed the paper and understood the cost.

Then I had the MRI, everything was standard with that. On my way walking out, I asked, "Hey, just curious. What is your cash pricing. Like, if I didn't have insurance, or if I chose not to use my insurance, what would it have been?"

"$550", said the office girl.



So obviously I was frustrated they didn't give me this option on their own (you know why), and I was paying $220 MORE for the MRI with insurance than had I chosen not to use it!

"Well, fortunately I haven't even left here yet, so you can back it out and process it as a non-insurance bill. So let's do that, and I'll let you run my credit card for $550."

Surprisingly, they said NO. They said that they already put it through as an insurance claim while I was doing the procedure, and it was impossible to back out.

Having done this once before years back (involving an ER visit), I knew they were full of crap. I told them they could easily back out the insurance claim, with the stated reason of, "Patient did not want insurance billed." This would cost them nothing except a few minutes of their time, and then I would be able to pay the non-insurance price, which was $220 cheaper.

Keep in mind that the non-insurance price WAS available to people who had insurance but chose not to use it (like me), so that wasn't the issue.

When I kept repeating that it was easy to back out and offered to call the insurance company to prove it, I got a new answer as to why they wouldn't: "Because it's our policy not to. We do not ever back out insurance claims unless there's an error. There was no error here. You agreed to put it through your insurance. You signed to it. We will not back it out."

So I told them to eat shit, that I wasn't paying a dime until this was settled, and I snatched back my credit card.

Before I left, I offered one more time for them to agree and run my credit card for $550 on the spot. They refused, so I walked out.

It took several phone calls -- first to the office manager (who hadn't been in that day), then to the district manager. Even the district manager, who fully understood my point and claimed my request "seemed reasonable", wasn't sure if he would do anything about it.

"It's still against our policy," he told me. "I'm not sure if I can violate that."

He also tried again to give me bullshit that backing out the claim would be violating their contract with the insurance as well as the law, both of which I shot down and offered to prove to him otherwise.

The call was cordial, but didn't really get anywhere. I finished by telling them I wouldn't pay a dime unless they reduced it to $550 and sent me a bill in writing indicating this. When asked why I wouldn't just pay $550 now and we would figure out the fate of the $220 later, I responded, "Because I don't pay incorrect bills. I owe you $550. Either that fully satisfies it, or I don't pay you a dime and you can sue me if you want."

After thinking about it for a few days, the guy called me back, and agreed to let me pay the $550. He sent me a correct bill, I paid the $550 on my credit card, and we were done.

"We've held onto this policy for years," he told me. "This is the first time we've ever made an exception. But you know, talking to management, we all understood your point. We told the office that from now on, they need to disclose both the cash price and the insurance price up front, and then let the person choose. So we've learned from this, and I apologize for the trouble."

[MumblesBadly]

A few years ago I had another absurd medical billing situation, albeit not as bad as this one.

I needed an MRI, gave the facility my insurance card, they checked it out, and they had me sign a paper that I would still owe something like $770 on my MRI out of pocket according to my benefits. Basically they were trying to protect themselves from people who claim shock when their insurance doesn't cover what they expected. I knew this going in, so I willingly signed the paper and understood the cost.

Then I had the MRI, everything was standard with that. On my way walking out, I asked, "Hey, just curious. What is your cash pricing. Like, if I didn't have insurance, or if I chose not to use my insurance, what would it have been?"

"$550", said the office girl.



So obviously I was frustrated they didn't give me this option on their own (you know why), and I was paying $220 MORE for the MRI with insurance than had I chosen not to use it!

"Well, fortunately I haven't even left here yet, so you can back it out and process it as a non-insurance bill. So let's do that, and I'll let you run my credit card for $550."

Surprisingly, they said NO. They said that they already put it through as an insurance claim while I was doing the procedure, and it was impossible to back out.

Having done this once before years back (involving an ER visit), I knew they were full of crap. I told them they could easily back out the insurance claim, with the stated reason of, "Patient did not want insurance billed." This would cost them nothing except a few minutes of their time, and then I would be able to pay the non-insurance price, which was $220 cheaper.

Keep in mind that the non-insurance price WAS available to people who had insurance but chose not to use it (like me), so that wasn't the issue.

When I kept repeating that it was easy to back out and offered to call the insurance company to prove it, I got a new answer as to why they wouldn't: "Because it's our policy not to. We do not ever back out insurance claims unless there's an error. There was no error here. You agreed to put it through your insurance. You signed to it. We will not back it out."

So I told them to eat shit, that I wasn't paying a dime until this was settled, and I snatched back my credit card.

Before I left, I offered one more time for them to agree and run my credit card for $550 on the spot. They refused, so I walked out.

It took several phone calls -- first to the office manager (who hadn't been in that day), then to the district manager. Even the district manager, who fully understood my point and claimed my request "seemed reasonable", wasn't sure if he would do anything about it.

"It's still against our policy," he told me. "I'm not sure if I can violate that."

He also tried again to give me bullshit that backing out the claim would be violating their contract with the insurance as well as the law, both of which I shot down and offered to prove to him otherwise.

The call was cordial, but didn't really get anywhere. I finished by telling them I wouldn't pay a dime unless they reduced it to $550 and sent me a bill in writing indicating this. When asked why I wouldn't just pay $550 now and we would figure out the fate of the $220 later, I responded, "Because I don't pay incorrect bills. I owe you $550. Either that fully satisfies it, or I don't pay you a dime and you can sue me if you want."

After thinking about it for a few days, the guy called me back, and agreed to let me pay the $550. He sent me a correct bill, I paid the $550 on my credit card, and we were done.

"We've held onto this policy for years," he told me. "This is the first time we've ever made an exception. But you know, talking to management, we all understood your point. We told the office that from now on, they need to disclose both the cash price and the insurance price up front, and then let the person choose. So we've learned from this, and I apologize for the trouble."

Great story. But most likely the manager is lying through his teeth about changing the policy. They prolly just don't want you going to the press about their shady dual-price billing. Because the healthcare industry's key to exorbitant profitability is opaque shady pricing and billing.

[BCR]

Yeah, with MRIs, X-rays, and a lot of bloodwork, you're better off bargaining or coming out of pocket. Especially bloodwork now that we may be heading back into free market system and you don't want that shit on your record like fender bender accident that stays on your record forever, as opposed to 3 years with auto. Plus auto insurance assumes you get better with age. With health insurance, it's the opposite. Random 35 year old shows up with a 275 cholesterol count on a blood test and he'll pay for it forever, even if a $4 script returns it to normal range. Tons of sites offer do it yourself bloodwork for cheap, plus if you need medication, some random doctor who oversees the whole thing and technically orders the test will call you in the script. They'll call it into Canadian pharmacy even.

[BCR]

Also, with all the talk of diabetes, I recalled reading a study, but couldn't locate it yesterday. Anyway, even though the BMI charts want you at 25 or below, research indicates that there is no significantly higher risk of heart or diabetes issues until you hit BMI of 27.8 for men, or 27.4 for women. Assuming Druff is 6'2, that's like 216 lbs, so it isn't like he's at some appreciable risk level at 225. Sure, he'd be healthier lighter, we all would, but he isn't in some danger zone. BMI is inexact, and hip to waist ratios and such may be more reliable, but the notion that you're some ticking time bomb at 6'2 225 isn't likely for most.

[ErickAA]

Agreed Druff at 6'2 225 isn't probably gonna be a problem. But I think middle-upper class people often don't realize just how obese lower class America is. My wife works in South Central Los Angeles, where it is mostly poor working class Mexicans, and if you look in the waiting room most of the patients are morbidly obese with horrible body fat distribution. Everyone (men and women) is pear or apple shaped with tremendous amount of fat deposits in the stomach/waist area. It is type II diabetes central.

[Dan Druff]

I thought about it over the weekend. That operations manager kept repeating, "We're going to bill this as a physical, that's going to happen". Even though he reluctantly agreed at the end of the call to hold off on actually billing it (when I demanded that), he didn't sound sincere, and I decided I didn't want to just sit on my hands and wait for the claim to come in and then have to fight it after-the-fact.

I called the insurance company and filed a report about this, and told the entire story.

They agree that, if my story is true, it was not a valid physical, since they backcoded it after-the-fact, and therefore performed it without my consent.

The lab work is trickier. I told them that I only had the lab work believing it was part of a physical, because they told me it was. Then, when the lab work was completed, they told me that I wouldn't be getting the rest of the physical (because I "already had it").

My argument was that I had the lab work under false pretenses (part of a physical they would not complete), and therefore it should not be valid or billable.

The insurance claims guy agreed with me, but said, "This is a unique one. I've never seen this particular situation before, so I don't know what to do."

So they're looking into what they can do when someone is essentially tricked into lab work as part of a greater fraudulent scheme.

Hopefully they will block these claims if they get submitted. I feel that's the best way to go about it, rather than waiting for the billing to go through and having to fight to back it out.

[Dan Druff]

Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for:

Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. -- NO

Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. -- NO

Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. -- NO

Fatigue. If your cells are deprived of sugar, you may become tired and irritable. -- NO

Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. -- NO

Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections. -- NO

Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance. -- NO

[gauchojake]

Do you know what CPT code they billed? You could also file a grievance with the DMHC if this is in CA http://www.dmhc.ca.gov/

[MumblesBadly]

Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for:

Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. -- NO

Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. -- NO

Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. -- NO

Fatigue. If your cells are deprived of sugar, you may become tired and irritable. -- NO

Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. -- NO

Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections. -- NO

Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance. -- NO

Likely only when insulin resistance is at extreme levels, not for early onset or moderate levels, because most people react to increased hunger and fatigue by overeating or bingeing on sweet items/candy, leading to weight gain from the other-than-glucose content of high calorie sweeteners that are ingested.

For example, 50% of ordinary table sugar (sucrose) is fructose, which first is converted by the liver into fat before being metabolized. Also, when you consider how much high fructose corn syrup (HFCS, which is as much as 90% fructose) is used in processed foods and soft drinks, moderate diabetics in the US are likley to gain even *more* weight if they respond to the increased hunger and fatigue by indulging in HFCS-sweetened foodstuffs.

[Dan Druff]

Do you know what CPT code they billed? You could also file a grievance with the DMHC if this is in CA http://www.dmhc.ca.gov/

No, I don't have any billing info right now. Not even sure if they billed it. At the moment, insurance has not received anything from them.

I do plan to file as many reports and grievances as possible if they do not come to terms with me, as well as sue them.

[Dan Druff]

Slimy operations manager called me back today.

"Nothing has changed. It's being billed as a physical."



Refused to answer my questions, and when I kept demanding a response, he would respond with mumbo-jumbo like "It was coded as a physical" or "You had a physical", and ignored all of my obvious and valid points.

At the end, when I threatened to bring on a regulatory and legal nightmare for them, AND to SEO it once I get court judgments or insurance rulings in my favor, he wasn't fazed, and told me to go ahead.

I think this is a scumbag place where they've probably dealt with legal issues before, and don't give a shit. Or, simply put, scammers aren't very afraid of being sued.

As a final act to resolve this before I take further action, I will call their COO, whose info I got from the operations manager.

I was told that he "knows everything", which is probably accurate. I am guessing that the rottenness goes all the way to the top, and they are going to give me the finger.

I hope the insurance rules against them. Glad I filed my report today.

Will also be submitting a grievance through the link gauchojake provided, as well as anywhere else I can find. (However, apparently I have to wait 30 days to file that grievance, according to the rules.)

Will proceed with lawsuit if necessary.

And I will SEO any decisions which go against them. Fuck these scammers.

[Dan Druff]

What sucks is how I can't even withhold any payment. It's all in insurance hands.

That's because a physical is 100% covered once a year by ACA plans, and I already paid my copay on my credit card.

If I reverse the $30 copay, the credit card company will just eat it (since it's not worth investigating for that amount of money), so these fuckers will still get paid.

I actually wish I still owed them money, so I could refuse to pay at least a portion of the bill.

I will press very hard with the insurance to rule in my favor, and hopefully to kick these SCAMMERS off their network.