[judydone]

My doctor ordered a test that my health insurance said was "medically unnecessary". The
Doctor did not discuss this with me before taking the test. Now I am expected to pay for
Something that I did not need. In addition the doctor wants a repeat of the test. I am on
Medications that I cannot stop taking and I am told that if I want to see the doctor I have
To pay the bill. This bill is only 4 months old.

[jenniepepsi]

Even though the insurance company says it was medically unnessisary, does NOT mean that it WAS medically unnessisary. They just don't want to pay for it because they feel it wasn't needed.

Your doctor ordered a test because he thought it was needed.
May I ask what the test was, or for. That may help understand the situation.

[dontknownuthin]

It's hard to say that your doctor is unethical based on this scenario because insurance companies often refuse to pay for what the doctor deems necessary. The doctor's responsibility is to make sure to look out for your medical wellfare, and he also has to protect himself from malpractice claims and many doctors take a very cautious approach, testing when there's any concern. The insurance company's goal is to pay out as few claims as humanly possible, so they often refuse. They don't deal with individual people but rather with actuarial tables and make decisions about what to cover for you based on the odds.

I mean, I would say it's unethical to charge for a test you didn't get, or to do a pregnancy test on an 80 year old woman, but unless your doctor did some test that was outrageously irrelevant, I would not deem it a slip in ethics.

Perhaps you can ask your doctor to make a case to the insurance company for why he did the test the first time, and why he's now requesting it to be repeated. You can always appeal the insurance company's decision, and I think you should. And if the bill is in dispute, you should be able to continue to get medical care during the resolution of that dispute.

[JudyKayTee]

I don't find it unethical - and I deal with this on occasion.

Two things - you can appeal your health insurance company's decision, using a letter from the Doctor explaining his decision to order the test; you can also notify the Doctor that the health insurance did not pay and you feel he should have so advised you. It is not his job to keep you informed (I always call the insurance carrier first because I went through this many, many times with my late husband) but I would at least mention it.

The Doctor ethically has to do whatever it takes to diagnose and treat - that is not the same responsibility that your insurance carrier has to I would say that the Doctor was not out of line. If he had not ordered the test and, therefore, missed a diagnosis, then he would be liable.

There's a NY case within the past month where a Physician ordered a colonoscopy, the health insurance wouldn't pay for it (I believe it would have been her second in 12 months), the Physician told the woman to wait out the year, she did - and they found colon cancer which had spread.

Guess who she's suing? The Doctor.

[Fr_Chuck]

First of course the doctor does not know what your insurance will or won't pay for when they do the treatment.
The doctor felt you needed the test, so most likely it was, your insurance merely does not pay for
Certain tests often even if you need them.

[J_9]

First of course the doctor does not know what your insurnace will or won't pay for when they do the treatment.
The doctor felt you needed the test, so most likely it was, your insurance merely does not pay for
certain tests often even if you need them.

Sorry Chuck, I beg to differ. We know what is and what is not covered. However, we order tests regardless if it is covered if it is in the best interests and well being of the patient, after which we can negotiate with the insurance company.

At this point it is up to the doctor's office to speak with the insurance company to impress the importance of the test so that it is covered.

[dontknownuthin]

Also, who is telling you you can't see the doctor until you pay the disputed bill? That's goofy.