Thursday, July 8, 2010

questionable ethics?

I’ve been frustrated all afternoon.  I wonder, sometimes, about why doctors and dentists would employ questionable business practices and still be highly recommended by their peers.  For their medical expertise, I guess.

Today Emily had a consult with an oral surgeon.  She needs to have her wisdom teeth pulled.  No question there…I’ve seen the x-ray and I trust our dentist.  He’s a good guy who knows we have 6 children.  :)  And the oral surgeon, himself, is okay too.  He did Hailey’s wisdom teeth last fall.  But since Hailey had her teeth pulled, I’ve learned some things and I don’t intend to make the same mistake twice. 

Once the consult is done, the surgery is scheduled and a worksheet with the fees is prepared.  So far, so good.  Then the estimated insurance payment is determined (based on the remaining amount of coverage for the year…in Em’s case, quite a bit) and subtracted off the total bill.  Then you get a piece of paper stating that you must bring the entire balance in a check to the office the day of the surgery.  No credit cards.  No payment plan.  No choice.  No money?  No surgery.  Okay…but for Emily the total is over $1,100 that we have to pay the day of surgery.  The problem is this:  the oral surgeon is a preferred provider for our insurance.  I KNOW what the schedule is for his payment. I KNOW the percentage our insurance covers and the percentage I am responsible for.  And I KNOW that he has agreed to ‘write-off’ a portion of the cost, since he can only recover the ‘allowable’ amount.  And the allowable amount is roughly $600 less than we are being charged.  That’s $600 that I have to pay up-front, then once the insurance pays the bill and I make a phone call reminding them that they owe me money, they eventually return the $600.  Money that they’ve earned interest on for roughly 6 weeks  (Yes, I know that’s not much any more, but still…)  Money that they KNOW isn’t theirs to collect in the first place—they have a contractual agreement with the insurance company! I learned all of this the hard way last year.  When I set up Emily’s appointment, I didn’t even think about it…until this morning when we walked in the office and it dawned on me:  “I’m going to have to do this dumb thing with them again.”  So I asked about it when we did the money part.  The gal at the desk was almost rude as she stated that this was the way they did things—they had to make sure they had their money. 

When I got home, I stewed for a bit then made 2 decisions.  First, I’m going to call the insurance company in the morning and ask them about this practice.  If' it’s ‘legal’ in their minds, fine.  Then I’ll move forward with the second decision.  I have several recommendations for a new oral surgeon, so I’ll call some of those guys.  I’ll ask about their financial practice (their surgery skills already come highly recommended!) and start this whole process over.  Again.  And I will call the oral surgeon and tell them I need my panoramic x-rays back.  That they can have Em’s scheduled surgery date back—that I refuse to deal with such a financial practice.  It may be legal, but it’s entirely unethical.  His loss.  After all, I have 3 more children who will need to have oral surgery in the future.  And I have some strong feelings on his financial practices that I’m not afraid to share. 

Maybe I’m way wrong here and this is how all oral surgeons run their practices.  I sure hope not.  I would hate to think that all of them think it’s okay to take money from patients that they KNOW isn’t theirs, even for a few weeks.  For some of us, that kind of money isn’t just pocket change.  And it’s definitely worth fighting for.


  1. I completely agree with you, Jennifer. The way insurance and doctors play around with money aggravates me. And many of us don't HAVE the money to be handing over to them to play with for a few weeks at a time. I hope you are able to find an oral surgeon with better financial practices.

  2. It's not just the dentist or oral surgeon! Cullen needed a CT Scan a couple of weeks ago. I requested we be sent to Children's Hospital. The nurse scheduled us for the hospital the doctor's office is temporarily located. We had to pay for "our" part of the CT Scan before they would do it! Children's bills patients AFTER billing the insurance! I'm not a happy camper and have let our doctor's office know about it.

    Give 'em hell!

  3. Just thought I'd throw in my 2 cents. ;)

    Our dentist pre approves every procedure, even cleanings. We do pay the remainder on the day of the appointment, but not until after it is finished. There have been two bills that we had to pay later because the insurance company paid less than expected and our dentist office just sent us a bill and worked it out with us. They are even willing to spread things out over 3 months if we really need to... I think I would find a new dentist/surgeon! ;)