Dr. problems

LONG post warning. I have used meds to monitor chronic pain for over 20 years and work as RN. I was injured in a car wreck, and my orthopod put me on disability. I ve had 15 plus knee surgeries after wreck. Two total knees, still non functioning. Pain and swelling persists. I was seeing a pain management dr. who left town, and I went to the primary dr. she had take over her practice about 8yrs. ago.

He has made multiple changes to his practice. Started out he wanted me to come in every month and get my scripts. After about 4 years. he came up with this idea, that he would have a new practice, and his patients that wanted to see him would pay $20 monthly if on Medicare, and $65 monthly if no insurance or commercial insurance. ON medicare, you would only owe your deductible, in addition to your monthly fee taken out of the bank account monthly. NO coinsurance would be owed or filed. The regular insurance would not be filed either, and office calls, etc would all just be part of the service. This was to do away with filing insurance.

However, he would file medicare and collect whatever they paid him. The patient just would not owe any additional amount to the $20 monthly. IF we wanted to continue to see him, we would join. I figured, it cost me $21.40 monthly for co insurance and I had to go in each month. This way I could just call and my scripts would be faxed. We were also to have 24 hr. daily access to him, by phone, and an apt within 24 hours if we needed one. From Jan 2016 when it started till 2017,no appts were ever necessary. I had one yearly exam in jan 2017, till he dissolved the practice with no notice in Aug 2017.

I never made any calls except my monthly 3 days before to fill my script. IN Aug, when I called for my meds I was told that practice no longer existed, and I would need to call back to his original clinic and get an appt. There I found out he had been bought out by a Hospital about 100 miles away. Upon arrival, I was given a letter stating I owed $196 from sometime in 2014 and 2015, and I MUST PAY IN FULL plus $200 deposit, before my next appt. I was also told that they had been turned to collections in Feb.2017, the day after they posted my medicare payment.


. YET< I have Never received any phone call message, voice mail or actual mail from the collection agency. There are 4 visits involved. 3 from 2015, evidently and my Jan 2017 visit. None of my pre collected payments showed on my acct. The payment would post as neg, be added back as positive, the neg again and then positive Therefore the starting amt owed as designated by medicare, after two already made payments made the ending balance the same as the beginning even though, I d paid $30 IN Jan 2017 I received notice from Medicare that I owed !01. deductible. THE DAY I GOT THE NOTICE< I took the payment in cash to the ofc manager at the pay as u go clinic and he told me that he did not take money to take it back to the original clinic. I went there and they had not posted the medicare payment and their payments "float " till Medicare pays , I have previously lost $50 and $70 that they never posted to my account.

So, I chose to wait and asked them to bill me when insurance paid. NO BILLS FOR OVER 2 YEars. This clinic is notorious for not filing for up to a bout 6 to 10 months after the fact of the appt. Back to letter. I looked at the first account listed, and it was for co insurance, I DID NOT OWE as I was part of the pay as you go clinic. SO, the ofc receptionist said that s right take it off. Down to $174 THe other 3 I may have owed $21 ON THE THREE, but they had been misfiled as rural clinic visits in 2015, and never billled to me. I actually had office visits monthly at that time. and not rural clinic visits. I saw him every month in the same exam room in the same building. So I take the letter, see the dr, WHO SAYS NOTHING, about this bill.

When I get home I look at the bill and find out about the rural clinic mis filings. and call Medicare, who tells me it will have to be refiled. SO I send a check and explanation of what I found (I Had previously been a credit manager for a clinic) and it is about $33 different to the office, as I have no address for the collection agency. I tell them to feel free to give it to the collection agency. WELL < I call for my next apt, as the DR is holding my scripts till I get an apt, and wont give me the apt until I pay the bill, I have been on these meds for 24 years. SO he sends back the check, and his receptionist tells me "DR. P is adamant that you pay the $200 deposit as the new hospital requires it."

I did not think due to their lack of billing and billing errors I should have to pay it. By this time, my meds are 10 days overdue, and I have so many personal things going on I decide to just pay it, ALTHOUGH HE SENT back my check. I d sent. so I call back the receptionist and he tells me "Dr said only way to not pay the $200 is to get a letter from the hospital."

I call the so mentioned hospital, and am told they did not partner with him, but the professional group had so she transfers me to that billing clerk Toni there who tells me That they had joined with the dr and this was the FIRST group of six that they "DID NOT DO THE BILLING OR INSURANCE and had Nothing to do with it. " IN addition, they had NO RULES REGARDING Payment in full or deposits of any amount before seeing the dr. Said she would talk to her manager and get back to me. WELL SHE CALLED BILLING AT MY DRS OFFICE and left a message.

Two days later I get a letter in the mail. that says. "DUE to our inability to resolve billing issues, I will no longer see u as a patient. Signs it and personally writes. Teresa, my feelings about our billings issues is overriding my feelings about your care, and you deserve better than that. " Signs it after telling me I am not to be seen by any dr there or at any of the 6 urgent cares in surrounding communities.

NOW< this is not about billing. This is about the fact that he lied to me and I found out because he lied to me. His receptionist told me to call and get a letter so I did. HE never spoke one word to me about the bill. and the errors are all the fault of his head clerk whom he hired off the street, who once told me that inpatients don't get billed.


They also kept billing me for outpt labs, till I took my medicare book in 4 years ago and showed them medicare paid 100% for outpt labs. This dr, like many others, just doesn't want to prescribe my pain meds. There are no other drs. in my town, closest is over 100 miles away. He also included a note that 30 days meds had been sent to my pharmacy. I went to get them 3 times before they were there a week later. This dr is aware I will find no dr in 30 days, where I live, esp around the holidays.


AFTER 8 years, he dug himself into a hole, by expanding too rapidly, forming multiple different practices and then needing to be bailed out. Then he directly lied saying the new provider required things they did not. Toni, even tried to get me to travel to their hospital about 120 miles away. In addition, I talked to multiple pts of his original practice, who also were to have been turned to the collection agency who never heard from it in the past year either.


This is a "man of faith" who repeatedly tells of the vision of his clinic, to care for the whole patient, their family , friends neighbors, and extended family. HAS IT POSTED ON HIS WAITING ROOM WALL. NOW money is all that counts. Although I am aware it will probably do no good, I m turning him in, to the new provider that bought him out, and the medical society. HE finds me so disposable, after I ve been the model patient for over 8years, doing everything he asked, never bothered him with phone calls, followed his protocol to a tee. EVEN when "Obamacare " as he calls it came into effect, and he told me that it required me ( who only had Medicare) to have monthly drug tests.


I called and asked Medicare and they said no I did not have to, but I never told him. After the first time and medicare did not pay, he never asked again. IN addition, the biggest reason I did not want to give me $200 is that his office has not even filed my Aug 2017 apt yet with medicare, and it would be over 2 years be fore I used it up. This has to stop. I ve been a legitimate, rule abiding, never called early never asked for more or early meds from him in 8 years. BUT what he doesn't like is being called on the ignorant billing system he has , knowing he is wrong. BUT directly lying to me was absolutly wrong. HE is now embarrassed that he has repeatedly lied and blamed it on the hospital taking over. Probably is collecting the money to get some back.


Drs, and employess have quit this office, due to paychecks being late, and one dr said costs way too high to him to work there at all. HE did not make any attempt to discuss this with me, and then said we had differences we could not resolve. Blaming me wont solve his problems. BUT has put me in a terrible place, with no way to get meds. This is how I m paid back for being as good of a patient as I could be. Professionally, I cooperated with everything he asked. He cant seem to find what makes him happy, and drags his practice from one type to another. I guess I wanted sympathy, I have no idea what to do, By the first I will have a week of meds left, and will not get a new patient appt then. Plus IN MO< u cannot depend on the weather. Feeling sorry for my self, but more angry that somebody else has that much control over my quality of life.



I made paragraphs to make your post easier to read.

Post Edited By Moderator (straydog) : 12/19/2017 4:38:36 PM (GMT-7)

Wow! So sorry this happened to you. As if we pain patients don't have enough to worry about as it is.

I read and re-read your post and I really cannot figure out what this Doctor was trying to do. The following is what I found regarding Medicares rules on what a Doctor can charge.



"Participating providers agree to accept Medicare’s fee-schedule amount as payment-in-full for all Medicare covered services. When Medicare patients see participating physicians and practitioners, they are charged Medicare’s standard amounts and do not face higher out-of-pocket liability than the regular 20-percent coinsurance on most services. Participating providers may collect their applicable fees directly from Medicare. The vast majority (96%) of physicians and practitioners registered with Medicare are participating providers."


I know for a fact that Medicare has no rules on how often UA's are done. My Doctor does them quarterly. I cannot imagine that Medicare would want to pay for a UA on a monthly basis.

Used to be that I believed whatever a Doctor told me, but it seems you can't trust anyone anymore. If something sounds fishy, I assume that it is and would probably move on to someone else. Although in your case, you really didn't have any other choice and I get that.

Is it a possibility to talk to your family doctor (or a doctor of any kind that knows you well) and ask them to script your meds just til you can find an alternative? LIke another poster said, everyone knows it takes time to find a new PM, plus as far as you are going to have to travel to see one. Wow! It's just a suggestion but might be worth a try.

I would think that if you remind the doctor as to how many years you have been on these types of medications, he or she would realize that it might be dangerous for you to be without them and should be willing to help out on a short term basis.

So sorry this has happened to you! Please keep us up to date on how things are going for you.

Take care,
Cindy

Post Edited (n2braves) : 12/19/2017 8:21:23 PM (GMT-7)

The real reason he cancelled me is I used to be a credit manager for an osteopathic clinic of several drs. I know the rules of Medicare and what they pay. In the past, he tried to charge me a 20 percent co pay for out patient labs, and medicare pays 100% of what they approve for these and there is no copay. I hjad to take my book in to prove to him. At my next visit, he told me I "really pissed him off" HE fired me from the practice as he got the call from the new owner billing clerk that told me everything he said was the exact opposite of what was the truth. HE was pissed that I found out. I believe he is trying to collect $200 deposit for money to keep the clinic going. HE way over ex panded in the 8 years and doesn t file medicare claims for at least 5 months after the fact so has no money comeing in. I have written a letter citing the past 8 years and sent a copy to the quality assurance dept at the new owner of the clinic. I have already cited to him that he knows as well as I , that I will not be able tofind another provider in my town, let alone in 30 days I need at least 90 days worth of meds. AND he also knows what it will do to my body. Have not heard back. I also question he did not send the letter registered when he dismissed me from his practice.

Purplereading:
How are you doing? This is a small forum. We genuinely care for each person who posts. Sometimes this forum is the only safe harbor for someone to express themselves and receive support and kindness.

I was a physical therapist and Healthcare consultant before ill-health found me. I thought I knew how to navigate the maze that is medical care. Nope. I have encountered more incompetent care than competent care.

Medicine is big business. Net profit reigns. Even as people suffer.

I hope you are doing as well as can be.
Karen

The prescribing guidelines Medicare is using was put into effect by the CDC & FDA. These guidelines have been in effect for quite some time, they are not new. PM drs also started going by these prescribing guidelines to keep from being flagged. Several years ago many patients suddenly found their dosages vastly reduced or cut off completely with no options except to try to find another dr. When these patients were released by the drs they were not given medication until they found another dr. Some states has adopted stricter prescribing practices. Pain mgt is so restrictive & getting worse.

I highly suggest that you lay off trying to expose this dr.. You are making a paper trail that will follow you around. This new dr in all probability will have you sign a release to obtain your records from the previous dr & you have no idea what has been put in your records. I would tread very lightly. As angry as you are it is not helping you at all. If there are negatives things written in your chart the new dr may decide he does not want you as his patient & it is his right to make that decision. This may all work against you in getting future care. Being a nurse you are very much aware of how drs have a certain kinship even if they disagree with what another dr has done with a patient.

I have been on Medicare for years & have never had to sign anything for a chronic condition charge. I have regular Medicare & a supplemental policy. On my EOB's from Medicare it asks if charges are Medicare approved. I have never been checked on several times a month by someone either. Not sure what you are talking about. I am under the care of a few specialists & treating me can be sketchy at times. I am guessing you have a Medicare HMO or advantage plan since you have co-pays.

I always look at every EOB from insurance & Medicare. If I had a question on something not being paid I would call insurance before calling the drs billing office. More often than not it was a CPT code entered incorrectly & it would be rebilled & paid. A little over 4 years ago my PM dr retired & referred me to a new dr. He was filling my pain pump & his billing office had my insurance messed up. They were billing the secondary first & of course no payments were made. In the computer at the drs office they had my insurance correct & they made numerous calls to billing. After about 8 months of this mess, I had an appt with my dr & I told him what the billing office was doing. I explained his office was not at fault & were getting no where with the billing office. First off, he was surprised that I had even bothered to look at my EOB's & I told him, I look at every one that I get plus I can go online & check things out. He said not many people do this & I appreciate you bringing it to my attention. I told him that I did not think I was a patient that fell through the cracks with that office & there was no telling how many others he had not been paid on. He had no idea there was a problem with his billing office. He ended up firing that billing office & I have never had another problem. Point is, drs rarely get involved with billing, they have a staff that does all of the coding for billing & then the billing office takes it from there. What your prior dr was doing I have no idea.

Some drs will not prescribe meds on the first visit so do not be surprised if this happens. Often we see the dr require a UA & then the patient goes back in 2 weeks & he makes the decision on meds.

Take care.