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  1. #1
    Join Date
    May 2006
    Posts
    285

    Default Fraudulent medical charges

    I need some advice, and I'll try to keep this short:

    A little over a year ago, my son fell off the couch and I thought he may have dislocated his arm. I took him in to the pediatrician, but ended up meeting with the PA, who I couldn't stand from the get go. She said she thought he had 'nurse maid's' elbow, which I think is just dislocated. She specifically said that if he did, he would cry out in pain during her treatment of it. Her treatment of it literally consisted of holding his arm out straight, and then bending his elbow while twisting his forearm. That was it. He didn't make a peep, and she said, "Hmm, maybe that's not what he had."
    Fast forward a few months, we get a bill for $176 for her "treatment" of something she admitted he may not have had. We contested the bill, and even ended up having a telephone conference with the PA, and the office lawyer. We told them flat out that we believed these were fraudulent charges and we would not be paying the bill. A year goes by, we hear nothing, so we figured they let it go.
    Today, just got a notice in the mail that they can no longer service out children, (which in itself is funny because we switched offices immediately following this incident) and they are turning us into collections.

    I am not above paying what I feel is a ridiculously high charge IF I FEEL IT IS JUSTIFIED. But I truly feel this is fraudulent. So what are our options? How do we go about handling this situation. DH and I have excellent credit scores, and have never had an issue like this before. What can we do to protect ourselves?
    To write with a broken pencil is pointless.

  2. #2
    Join Date
    Jun 2005
    Posts
    4,863

    Default

    Was the $176 in addition to an office visit charge? If that was the only charge I'd pay it (it sounds like a typical office visit amount). If the $176 was in addition and listed as a "treatment" charge I'd contact the office again. Reference your last conversation and the amount of time in between. Ask why you are now getting charged again.
    babygirl 10-29-07
    baby sister 7-17-11

  3. #3
    Join Date
    May 2006
    Posts
    285

    Default

    I paid a $20 copay for the office visit. The $176 is the charge for their "treatment" of his elbow. This is the charge we disputed from the beginning, because it is a false charge.
    To write with a broken pencil is pointless.

  4. #4
    Join Date
    Jun 2005
    Location
    Chicago
    Posts
    5,191

    Default

    It sounds like you just owe for the visit, not necessarily the 'treatment'. I went to a quick care clinic where the NP told me I had a cold, and I had to pay them for the visit, even though they didn't necessarily 'treat' anything. I had to pay for their time, their office overhead, etc... Fair enough.
    She'd be his wife and make him her husband 5/03Ds1 12/22/09...Ds2 8/31/12

  5. #5
    Join Date
    Jun 2005
    Posts
    13,322

    Default

    If you paid a copay, I'm assuming you have insurance? What does your insurance company say? If the charge to go into the office, have the NP look at your child and attempt to diagnosis the issue was a $176 charge, then I'd say you are liable for it. Whether she got it right or not is not the issue. It's that you took her time and you have to pay for it.

  6. #6
    Join Date
    Jul 2005
    Posts
    942

    Default

    My daughter has had nursemaid elbow a few times, and what you describe the PA did, is they way they fix it.
    I don't see why you think you don't owe the $176. If your ribs hurt and your doctor takes x-rays to see if you broke a rib and the results say you didn't. Do you then think you don't have to pay for the x-rays?
    I'm sorry they haven't dealt with this in a timely manner (sending you a bill a year later is ridiculous, IMO) but I do believe you are responsible for the charge.

  7. #7
    Join Date
    Jun 2005
    Location
    Gulf Coast
    Posts
    7,462

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    You are being charged $176 for a PA to bend your child's elbow? Plus the co-pay? WOW!

    I'd contact your insurance and see what they say.
    1+1=5! Baby #3, Aug 2012!

  8. #8
    Join Date
    Jun 2005
    Posts
    1,988

    Default

    How exactly is this "fraudulent?" That's the treatment and the method of diagnosis for nurse's maid elbow. They performed the service, and they charged you for it. Is it expensive for what seems a pretty minor service? Yes, but medical charges are expensive.

  9. #9
    Join Date
    May 2006
    Posts
    285

    Default

    Hmm, clearly I'm in the minority here.

    Yes, we had insurance at the time, (though our insurance was switched a few months ago, and the new insurance will not cover it either since it was before we had them.) The old insurance refused to pay it, I believe due to a coding issue.
    The bill they sent us last year clearly stated that it was for the treatment, our insurance covered the examination itself.

    I guess I feel it is fraudulent because of what the P.A. said to me during the visit. She specifically said, "when I manipulate his arm, he will cry out in pain once the arm is reset." Then when he did not make a sound, she said, "Hmm, maybe that's not what he had." So I feel like she is charging me for a treatment to a condition he did not have. You wouldn't pay for someone to cast a leg that wasn't broken, would you?

    Trust me, with three kids I have willingly paid for plenty of medical charges I feel are extremely high, and I am not just trying to screw the system. But I also am very careful about medical bills, and really try to ensure I am not getting screwed either.
    To write with a broken pencil is pointless.

  10. #10
    Join Date
    Jul 2005
    Location
    Iowa
    Posts
    4,699

    Default

    Quote Originally Posted by JenK View Post
    Hmm, clearly I'm in the minority here.

    Yes, we had insurance at the time, (though our insurance was switched a few months ago, and the new insurance will not cover it either since it was before we had them.) The old insurance refused to pay it, I believe due to a coding issue.
    The bill they sent us last year clearly stated that it was for the treatment, our insurance covered the examination itself.

    I guess I feel it is fraudulent because of what the P.A. said to me during the visit. She specifically said, "when I manipulate his arm, he will cry out in pain once the arm is reset." Then when he did not make a sound, she said, "Hmm, maybe that's not what he had." So I feel like she is charging me for a treatment to a condition he did not have. You wouldn't pay for someone to cast a leg that wasn't broken, would you?

    Trust me, with three kids I have willingly paid for plenty of medical charges I feel are extremely high, and I am not just trying to screw the system. But I also am very careful about medical bills, and really try to ensure I am not getting screwed either.
    I'm going to have to agree with the others. How was the PA to know that's what your son had without trying to treat it? Did you expect them to do something different to determine if it was a dislocated elbow? If you feel like she wasn't competent, then you should have asked for somebody different at the time your ds was being seen.

    I wouldn't pay for a cast on a leg that's not broken, but I absolutely would (and have had to) pay for xrays to determine a diagnosis. Once in my cat (turned out not to be the case, xrays didn't do anything other than help us with process of elimination) and once with my daughter who did have a fractured bone. Casting is only done after xrays to determine the injury. I assume in teh case of nurse maid's elbow, that a prefessional would do the elbow bend thing to both diagnose and treat and if it doesn't work, then that's not the problem afterall.
    DD8 DD7 DS2.5 DD 10.26.13

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