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zolu0shka · Jun 9, 2008, 07:19 AM

Hello
I took my son for vision exam. The appointment lasts 5 min, doctor just checked his vision using the chart on the wall.
Later we received $185 bill for COMPREHENSIVE EYE EXAM!! The same thing happened to my friends and their children, $185 for 5 min exam!
This is a complete fraud! Comprehensive exam lasts at least 30 min and includes usage of eye drops and full check of eye on machines. Nothing of it was done.
My insurance refused to pay this bill, because we have a vision plan VSP, but this doctor did not accept VSP and bill is on us now.
I would like to do two things - first, to dispute this bill and narrow it down to the reasonable cost, and second - report this doctor to... ( I do not know to whom) for fraud.

How do I do it? Please, help. Thanks

progunr · Jun 9, 2008, 08:35 AM

Did you discuss the cost of the exam prior to having it done?

That would have been my first question.

You can dispute with the doctor, probably won't get far, but you can certainly object.

If he did not charge you more than you were told the exam would be, then there is no fraud.

If he didn't tell you how much the exam was, and you didn't ask, I believe you will be responsible for the $185, but it's worth the fight to try to get it negotiated to a lower amount.

Fr_Chuck · Jun 9, 2008, 08:52 AM

1. Did you discuss the cost prior to service
2. did you ask about what insurance they accepted, and if you had insurance why did you not go to a provider that would accept your insurance
3. You may write them a letter of protest stating you did not receive the services you believe you were billed for.
4. You can report him to the BBB and to the state attorney general if you wish.
5. and you can refuse to pay, let them sue you and see if the courts will or won't agree with you

ScottGem · Jun 9, 2008, 08:57 AM

All goodf answers. Each state has licensing boards for physicans. Check in your state for an optometrist's agency to discuss this doctor's practices.

zolu0shka · Jun 9, 2008, 08:59 AM

I did not ask about the cost prior to service, nor did not ask if he accepts VSP

I did not ask for comprehensive eye exam, I just wanted a vision check. And what we got was a vision check anyway! Doctor just wand to scam the money by substituting a procedure name for more expensive one.

What is BBB?

Fr_Chuck · Jun 9, 2008, 09:35 AM

Sorry, assuming you are in the US, Better Business Bureau, and yes the licensing authority Scott mentioned forgot about them.

Also to protect your credit in case they wanted to sue you, you can pay ( know you don't want to) but then you sue them for part of the money back. You still get in court, but this way, they can't charge you late fees and you are in control of it as the one who was done wrong

** but lesson learned, always ask how much and what is being done and ask about insurance first.

I know I am a pain in their office, but the dentist has to let me to up front while I am in his chair and discuss prices of things he wants to do. I never say OK till I know the price and never go in, unless I know they accept my insurance.

zolu0shka · Jun 9, 2008, 10:10 AM

I did some research an found the list of procedures for comprehensive eye examination:
Distance Vision
Near Vision
Focusing Skills
Eye Tracking and Fixation Skills
Binocular Vision or Fusion
Convergence and Eye Teaming Skills
Color Vision
Reversal Frequency
Visual Memory
Retinoscopy
Random Dot Stereopsis
Lazy eye (amblyopia)
Misalignment of eyes (strabismus)
Inability to maintain alignment of both eyes for correct focus as distant objects move nearer (convergence insufficiency)
Focusing (accommodation), color vision, and/or depth perception problems
General eye and eyelid health
Examine the cornea and iris

Only first two were done.
I already found, where to go - I'm filing a complain to the Department of Professional Regulations

Thank you for your help

ScottGem · Jun 9, 2008, 10:46 AM

I think, you stand a good chance of getting the optician in trouble with his regulating agency. However, I think you will have trouble not having to pay this bill.

Since you didn't ask anything before hand, you have little to complain about.

LearningAsIGo · Jun 10, 2008, 11:34 AM

I have to back up a bit...

Routinely, a doctor has a "charge slip" that he marks the procedure he performed. This is turned into a biller who processes the claim. There are a few things that could have happened.
1. The doctor did indeed check the wrong box*
2. The biller transcribed incorrect information (reading the wrong line, etc.)*

*If these were mistakes or done on purpose, it will be nearly impossible to prove

If you haven't already done so, I would call the office and ask to speak to the office manager. Calmly explain the situation and ask that your bill be amended. If for ANY reason he/she does not seem cooperative, tell them you will contact the BBB to inquire about previous billing claims made against the practice. Usually, that's enough to get further cooperation.

Honest mistakes can be made (I certainly hope this is one) so try the simple approach before you pull out all the stops.

Good Luck

P.S. It is technically the patients responsibility to make insurance inquires prior to any procedure. Some offices are good about doing the "leg work" for you, but most will not supply this extra service of insurance precertifications.

zolu0shka · Jul 19, 2008, 08:39 AM

I already called doctors office and told them that I'm going to open a complain.
They called me back 10 min later and told me that I'M OVERCHARGED and will be reimbersed 50% of my bill!!
Ha-ha!