Title: What to Do When a Urologist Turns Out to Be a Fraudster?
Hi everyone,
I recently dealt with my first kidney stone, which was confirmed at the ER. After an out-of-pocket expense of $2,800, I was advised to see a urologist.
Unfortunately, the urologist recommended by the ER wasn’t available for a month. I tried another one suggested by a family member, but they were also booked for a month. My primary care doctor’s recommendation was met with the same issue.
When my symptoms worsened, I had to return to the ER, which cost me $1,800 this time due to my deductible being met.
In search of quicker help, I turned to ZocDoc and found a urologist with next-day availability. After visiting him, I provided a urine sample and was scheduled for two surgeries.
I made sure all necessary prior authorizations were in order beforehand.
However, I recently received an Explanation of Benefits (EOB) for my doctor’s appointment, which included another $1,800 charge for a DNA test I never had (I’m not sure what they did with my urine) that didn’t seem medically necessary.
It turns out this doctor is a complete fraud. In fact, the Department of Health and Human Services has issued a bulletin about him, yet my insurance company still listed him as in-network.
Now, I’m terrified—not only about what was done or not done regarding my health but also about the financial burden I’m facing.
Is there any hope for me? What should I do next?
I’m really sorry to hear about your experience; that sounds incredibly stressful. Here are some steps you can take to address the situation:
Gather Documentation: Collect all relevant documents, including your medical records, invoices, Explanation of Benefits (EOBs), and any communication you had with the urologist’s office or your insurance company. This will help you present a clear case.
Contact Your Insurance Company: Since you were billed for services that were not medically necessary, reach out to your insurance provider. Explain the situation, share the bulletin from the Department of HHS, and ask for a review of the charges. They may be able to assist you in disputing the claims or providing guidance on coverage.
File a Complaint: You should report your experience to the appropriate medical board or licensing authority in your state. This can help prevent others from going through the same situation and puts pressure on regulatory bodies to take action against fraudsters.
Seek Legal Advice: Consider consulting with a lawyer who specializes in medical malpractice or fraud. They can help you understand your rights and any potential legal actions you might take to recover costs or seek damages.
Monitor Your Health: If you’re concerned about whether any procedures were performed appropriately, consider consulting another urologist for a second opinion. They can evaluate your situation and provide guidance on any necessary further action.
Support System: It’s understandable to feel anxious about this situation. Talk to friends or family members who can provide emotional support throughout this process.
Stay Informed: Keep abreast of any updates regarding the urologist you saw, particularly if any further actions are taken by regulatory bodies. This can help you stay proactive in protecting your health and finances.
You’ve done the right thing by seeking help and being proactive. Take it one step at a time, and don’t hesitate to reach out for support along the way.