What to Do When a Urologist Turns Out to Be a Fraud?
Hi everyone,
I recently had my first experience with a kidney stone. After a visit to the ER, which cost me $2,800 out of pocket, I was advised to see a urologist.
Unfortunately, the doctor recommended by the ER had a month-long waitlist. I tried a urologist suggested by a family member but faced the same issue. My primary care physician’s recommendation also had a month-long wait. The pain escalated to the point where I had to return to the ER, this time costing me $1,800 as I had met my deductible.
Desperate for help, I turned to ZocDoc and found a urologist with availability the next day. I visited his office, provided a urine sample, and was scheduled for two surgeries. Before proceeding, I made sure to verify that no prior authorizations would be needed.
However, I soon received an EOB stating I was charged another $1,800 for a DNA test that I never had (which I still don’t understand the purpose of) and that wasn’t medically necessary.
It turns out this doctor is a complete fraud — even the Department of HHS has issued a bulletin about him, yet my insurance still lists him as in-network.
Here’s the bulletin for reference.
Now I’m incredibly anxious, not only about the treatment I received (or didn’t receive) but also about the financial burden I’ve incurred.
Am I in serious trouble? What should I do next?
I’m really sorry to hear about your experience—dealing with health issues is already stressful, and the situation you’ve described sounds incredibly frustrating and concerning. Here are some steps you can take:
Contact Your Insurance Company: Reach out to your insurance provider to discuss the charges incurred. Explain the situation in detail and provide them with the information regarding the fraud allegations against the urologist. They may have protocols in place to help you dispute unauthorized charges.
Gather Documentation: Keep a detailed record of all communications, bills, and documents related to the appointments and treatments. This can be crucial when disputing charges or if further action is needed.
Report the Urologist: Since the Department of HHS has already issued a bulletin, consider filing a formal complaint with them as well as with your state medical board. This may help protect other patients from similar issues.
Consult Legal Advice: If the financial implications are significant and you feel that you’ve experienced negligence or harm, it might be worth consulting with a legal professional who specializes in medical malpractice or consumer rights.
Seek a Second Opinion: If you have ongoing health concerns, make sure to see another reputable urologist for a second opinion to ensure that your health isn’t compromised further.
Emotional Support: It’s understandable to feel overwhelmed. Consider talking to a trusted friend or a mental health professional to process what you’re going through.
You’re not alone in this, and there are paths to help address these issues. Take it step by step, and focus on your health and well-being as you navigate this situation.