What to Do When Your Urologist Turns Out to Be a Fraud
Hey everyone,
I recently experienced my first kidney stone, which was confirmed at the ER. After paying $2,800 out of pocket, I was advised to consult a urologist.
I reached out to the urologist recommended by the ER, but he wasn’t available for a month. I then attempted to book appointments with other urologists recommended by family and my primary care doctor, all of whom also had a month-long wait.
As my symptoms worsened, I had to visit the ER again, which cost me another $1,800 since I had met my deductible by this point.
Desperate for help, I turned to ZocDoc and found a urologist who could see me the next day. I visited his office, provided a urine sample, and he scheduled me for two surgeries. I confirmed in advance that no prior authorizations were needed.
However, I was shocked to receive an Explanation of Benefits (EOB) stating that I owed another $1,800 for a DNA test I never had, and that wasn’t medically necessary either.
It turns out this urologist is a total fraud—so much so that the Department of HHS even issued a bulletin about him, yet my insurance still lists him as in-network.
Now, I’m not only worried about the procedures he performed on me but also the huge financial burden I’m facing.
What should I do now? Am I in deep trouble?
I’m really sorry to hear about your experience; it sounds incredibly frustrating and stressful. Here are some steps you can take to address the situation:
Document Everything: Make sure to keep a detailed record of all your interactions with the urologist’s office, including dates, services performed, and any bills or communication related to your treatment.
Contact Your Insurance Provider: Explain the situation to your insurance company and provide them with all necessary documentation, including the EOBs and the bulletin from the Department of HHS. Ask them to investigate the fraudulent practices of the provider.
Dispute Charges: If you believe that the charges are unjust, formally dispute them with your insurance company and the provider. Request a detailed explanation of the charges, especially for the DNA test that you did not authorize.
Reach Out to Regulatory Bodies: Consider contacting your state’s medical board to report the urologist. They may have procedures in place for dealing with fraudulent practices and can provide further guidance.
Talk to a Legal Professional: It might be beneficial to consult with a lawyer who specializes in medical malpractice or consumer rights. They can help you understand your rights and options, especially regarding any potential financial recovery.
Seek Medical Follow-Up: Since you have concerns about the surgeries performed, it’s important to follow up with another trusted urologist for a thorough evaluation. They can help you assess any post-operative issues or address your kidney stone situation.
Support and Resources: Consider joining support groups or forums with others who have had similar experiences; it can be helpful to share your story and hear how others have navigated these situations.
It’s understandable to feel anxious about everything you’ve gone through, but taking these steps can help you regain control and seek justice for this situation. Stay persistent and don’t hesitate to seek the help you need.