My daughter broke her arm last week. After a visit to urgent care to confirm it was broken, we were advised to follow up with an orthopedic surgeon and saw him today. My daughter's arm has been in a sling since last week, and had x-rays taken at urgent care. Both the sling and x-rays were provided by urgent care. I brought the x-rays to the orthopedic surgeon for him to read. He was in the exam room for 2 min. Never examined my daughter or laid a finger on her. There was no "treatment" other than he told me to keep her arm in the sling for 3 more weeks. Then at the checkout, I was handed a $1200 bill with $1019 for "treat humerus fracture" and $181 for office visit. He didn't treat her. I paid my portion ($338.31) but question his billing practice. How can I correct this? It seems wrong.I don't mind paying (or having my insurance pay) for services that were given. But, can he actually claim that he treated her? I feel like he committed fraud by billing so much for something he didn't do. I called my insurance company to get their advice on what to do or what can be done. The insurance company said that all I (my insurance) should have been billed for was an office visit.
It is best to first dispute this issue with the surgeon's office. If they claim the charge is valid and you need to pay, I would retain a local attorney to help you fight the charge. Be aware of attorney's fees and court cost if this becomes a bigger issue
This information does not constitute an attorney-client relationship until such time as we agree in writing to enter into an attorney-client relationship. This is general information that is given for legal education only. The information given is done so without knowing all of the facts and circumstances, and may not be applicable for your specific situation. I strongly encourage you to consult with a local lawyer who specializes in this area to get legal advice and help with your situation.
I would think that the insurance company would want to investigate that surgeon's billing practices. If they agreed that it should only have been an office visit, then they paid a large claim undeservedly. Also, this is probably not the only situation where the surgeon billed that way.
Has the insurance company said they are planning on doing anything about the situation? I think your best bet is to get them involved and working to have the surgeon refund both you and the insurance company. While you won't be able to get a lawyer involved for only $340, the insurance company has likely paid a lot more to the surgeon. With their greater financial stake, they should be interested in dealing with an attorney regarding the claim and you should be talk to your insurance company about how to be included if there is a settlement.
Please understand that this is only intended to give you a general idea about the problem. Without complete knowledge of the situation, nothing in my answer can be considered 100% for sure. Feel free to call for a complimentary consultation to see if I can provide a more solid answer - 989.506.7344.
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