What should you do if the urologist you consulted once and who performed two surgeries on you turns out to be a major fraud?
Hi everyone,
I recently had my first kidney stone, confirmed by the ER, which cost me $2,800 out of pocket. After that visit, I was advised to get in touch with a urologist.
The first urologist recommended by the ER was booked for a month.
I then tried one suggested by a family member—same situation, unavailable for a month.
I even reached out to one recommended by my primary care physician, but again, no appointments for a month.
By this point, my symptoms had worsened, and I had to return to the ER, this time only costing me $1,800 since I hit my deductible.
Frustrated, I turned to ZocDoc and found a urologist who could see me the very next day. I went to his office, provided a urine sample, and he scheduled me for two surgeries.
Just to clarify, I double-checked that no prior authorizations were needed beforehand.
However, I soon received an Explanation of Benefits (EOB) reflecting another $1,800 charge for a DNA test I never had (I have no idea what they did with my urine), which wasn’t medically necessary.
It turns out this urologist is a complete fraud. The Department of HHS has even issued a bulletin about him, but my insurance still lists him as in-network.
Now, I’m terrified—not just about what he may or may not have done to my health, but also about the financial burden I’m facing.
What can I do? Am I in serious trouble?
I’m really sorry to hear about your experience; that sounds incredibly frustrating and stressful. Here are some steps you can take to protect yourself and address the situation:
Gather Documentation: Keep all records related to your visits, including invoices, explanations of benefits (EOBs), and any correspondence with the urologist’s office or your insurance company.
Contact Your Insurance: Reach out to your insurance provider and explain the situation. Since the urologist has been flagged by HHS, your insurer may be able to assist in disputing the charges or reevaluating the legitimacy of the claims.
File a Complaint: Consider filing a complaint with the state medical board and the appropriate authorities (like the Attorney General’s office) regarding the urologist’s practices. This can help prevent others from going through the same experience.
Consult Another Urologist: It might be a good idea to see a reputable urologist for a second opinion, especially if you have concerns about any procedures or treatments you received.
Consider Legal Advice: If you feel it’s warranted, you might want to consult a lawyer who specializes in medical malpractice or healthcare fraud. They can provide guidance on your rights and any possible legal actions you can take.
Keep Records of All Future Medical Interactions: Make sure to document any further communications or treatments. This is helpful for both your peace of mind and any potential disputes.
Stay Informed: Educate yourself about your rights as a patient and the best practices for choosing healthcare providers.
Take care and focus on finding the right support and care moving forward. You’re not alone in this!