Title: What to Do When the Urologist You Trusted Turns Out to Be a Fraud
Hi everyone,
I recently had my first experience with a kidney stone. After confirming it in the ER and spending $2,800 out of pocket, I was advised to consult a urologist.
Unfortunately, the urologist recommended by the ER had a month-long waitlist. I then tried another one suggested by a family member, but once again, I faced the same issue. My primary care physician’s recommendation also wasn’t available for a month.
As my symptoms worsened, I found myself back in the ER, this time with an out-of-pocket cost of $1,800 since I had met my deductible.
Desperate for help, I turned to ZocDoc to find a urologist and found one who could see me the very next day. After a visit that included a urine sample, he scheduled me for two surgeries.
To clarify, I made sure that no prior authorizations were needed beforehand.
However, I soon received an Explanation of Benefits (EOB) for that doctor’s visit, which included an additional $1,800 charge for a DNA test I never had—an unnecessary procedure connected to my urine sample.
It turns out this urologist is actually a fraud. The Department of Health and Human Services even issued a bulletin about him, yet my insurance still claims he’s in-network.
Now, I’m really anxious—not just about what he may have done (or not done) to my health, but also about the financial burden I’m facing.
Do I have any options, or am I completely stuck?
I’m really sorry to hear about what you’re going through. It sounds incredibly stressful and frustrating. Here are some steps you can take:
Document Everything: Keep copies of all your medical records, bills, EOBs (Explanation of Benefits), and any correspondence regarding your treatment and the surgeries. This documentation will be crucial if you need to dispute charges or report the fraud.
Contact Your Insurance Company: Explain the situation to your insurance provider. They may have procedures in place for dealing with fraudulent claims and can guide you on how to possibly appeal the charges or seek reimbursement for unauthorized tests.
File a Complaint: Since the urologist has been reported by the Department of HHS, consider filing a formal complaint against him with your state’s medical board or licensing authority. They can investigate his practices and may take action.
Seek Legal Advice: It may be beneficial to consult with a lawyer who specializes in medical malpractice or consumer protection. They can advise you on whether you have grounds for a lawsuit and how to recover your losses.
Get a Second Opinion: If you’re concerned about any procedures that were done, consider seeing another qualified urologist for a second opinion on your condition and any necessary follow-up treatments.
Emotional Support: Dealing with a situation like this can be emotionally taxing. Don’t hesitate to reach out to friends, family, or a counselor to talk about your feelings and get support.
Remember, you’re not alone in this, and there are professionals who can help you navigate this complex situation. Stay proactive about your health and rights.