[imapatient]

What would you guys do if you were referred by your Pdoc to a T for what you were told by Pdcoc was a “test” for ADHD, and the session ended up being a half-day evaluation—MMPI, some other personality test, attention test-- and you ended up getting charged $300 as your part? I’m on SSDI and Medicare. I didn’t agree to anything like that sort of thing. The report evaluated me in seemingly every way. When I read it I thought, What? I thought I was just getting diagnosed for ADHD.

Co-pays to a T for me are little if nothing with Medicare, and I ended up with that huge bill. Maybe the tests cost so much. I’ve sat on it for months without paying it because I’m so ticked.

I haven't said anything to my P-Doc or that T yet--just met him once. But I feel like communication was very screwed up somewhere between the two of them. I should have asked more questions, but in a T session of any sort, you don’t feel like you’re at the car dealer where you’re going to be saying, “Wait, how much is that going to cost me?” before proceeding.

I feel like writing a letter to both of them explaining my feelings rather than just paying. I feel like I shouldn’t have to pay any but an amount akin to what I’d pay for a regular session. I don't know what to say, if anything, in a letter about what I sh/c/would pay. I don't do well when I feel a bit of anger; it sidelines me.

Part of me is ticked at the T and I feel like reporting those charges to Medicare as unauthorized. I won't, but it's a fantasy.

Suggestions for course of action?

[sunrise]

It sounds like you have a longterm relationship with your pdoc, so I think telling your pdoc the situation is a good starting point. You could explain what you told us here--that you thought pdoc referred you to T for an ADHD test, and instead, you had several unrelated tests administered to you without any explanation or your consent, and you ended up getting a huge bill. Ask his advice on whether you should report the charges to Medicare as unauthorized or what. Maybe he will have a good suggestion on how to solve this problem. It's certainly not your fault.

[imapatient]

Good idea, rather than approaching both at once or the just the T.

I'm not serious about reporting it to Medicare, that is my sort of revenge fantasy stemming from the displeasure, as it would be the extreme response. Not going to do that.

[cantstopcrying]

Speaking from someone who works in the medical field, it shouldn't be just a fantasy, reporting them to Medicare. Ask that you not be named, to avoid any uncomfortable feelings on your part and what they should do is a general audit of their billing practices. It's not uncommon. Medicare reimbursement continually is declining for most billing codes for most specialties and everytime fraud is commited, that just hurts everyone more. Also, in the future it would be an empowering thing for you to ask, "just what does (testing) entail or include". It's giving power to the patient, where it should be. Maybe their "normal" ADHD testing does include all those things you mentioned, but then you would have had the opportunity to decline one or all parts of the test. It's hard to do and a lot of providers aren't comfortable with patients being actively involved in their healthcare, but it's important to you and your health. Good luck and don't feel you shouldn't report them.

[Christina86]

All I can tell you is that generally, as has been my experience and other people I know - all of those evaluations ARE part of the ADHD screening test and stuff. You're actually fortunate, compared to myself - I was being tested for learning disabilities - it cost me over $1K - and went over three days.

[sunrise]

imapatient, when I had ADHD screening, I did a verbal screening in her office (questions and answers and ratings on Likert scales). She also asked me a number of questions about anxiety and depression, since they often co-present with ADHD, and scored me on those. And we chatted about what was going on in my life, what tasks gave me difficulty, any other problems, etc. She then gave me two written ADHD instruments, which I took home and completed. We then went over them together in her office the following week. My first appointment took over an hour (initial interview and evaluation), the second somewhat less. She never gave me any personality tests like the MMPI. The bill for my first appointment was $220. The bill for the second was $150. My insurance paid about 90% of these charges. (It was like heaven getting these charges reimbursed as my insurance doesn't pay a red cent for my therapist.)

If you feel there has been fraud/deception/erroneous charges in your care, I think you would be justified in reporting it to Medicare. Why would you hold back? (I do think talking to the pdoc is a good first step, though. Perhaps it is all a misunderstanding, and if the billing department understood what had happened, they would adjust the bill. But they can't know unless you tell them.)

[imapatient]

Well, there was miscommunication somewhere, From PDoc to me--he said a "test"--re: some given test, a computer -based thing. I don't know what he said to the T--there might have been a miscommunication. I bear some responsibility for not asking more questions up front, or along the way, but as I said, it's not like a typical commercial transaction. I kept going along with it, not knowing where it was going. And never being told that it would involve A, B, C, D....

I feel like given the miscommunication--that I assume happened, that I bear some responsibility for not trying to inquire more so upfront (but having been told how it would go), I'm holding back. I feel like reporting would only be appropriate if there were deliberate abuse of the system. Too much to suggest communication errors. I was originally referred to someone in the actual practice of my Pdoc, but Medicare wouldn't cover it unless done by a PhD or MD, so I was referred to an affiliated clinic. Maybe the information difficulty stemmed in part from my Pdoc not being used to dealing with that T about the issue.

Thanks for the comments.

[sunrise]

I saw this article today on MSN and thought it had some good tips:

5 tips for haggling over medical bills
http://articles.moneycentral.msn.com...icalBills.aspx

[imapatient]

Below is a draft of the letter I'm thinking of sending to my Pdoc about the situation. I'd appreciate feddback, as I have trouble communicting when I bear any anger in a sitution re: emotion and clarity. Thanks

Dr. V,

I’m writing about concerns relating to my session with Dr. D last November.

There was miscommunication or misunderstanding somewhere, and I’m left with a $260 bill that I had no expectation of receiving in such a high amount.

You referred me to someone in your office to evaluate me for ADD for what I understood to be a computer-based test that takes about an hour. The office later told me I couldn’t see that person because Medicare wouldn’t pay unless the administrator had a PhD. I was scheduled to see Dr. D on recommendation of I’m not sure who--yourself or the office staff.

I went into the meeting with Dr. D expecting a “test” session. What I received was an approximate 3.5-4 hour evaluation of many sorts. I had the understanding during all of it that it related to ADD evaluation. He gave me an MMPI, another personality test, a computer response test for attention-testing itself, long verbal questioning. I never knew that anything but ADD evaluation was going on, and he never explained to me what the whole process was going to consist of.

When I received his follow-up report, I was shocked that he seemed to assess me for so many issues and diagnose me for multiple conditions. I thought of writing a response to the report because of what are inaccuracies—factual and impressions, but decided to let it go. I felt he wasn’t in a position to make such judgments based on one meeting.

I received a bill in spring that was unexpected. I’ve requested a new copy of the report verbally once via a phone message and twice in filling out a formal written request provided and have never received a response. I finally (thought I) paid the bill as of a few months ago via a payment at your office—the same billing co. is used by both yours and his practice. I’ve now received letters from a collection agency.

In re-thinking—as I had originally, hence my delay in paying—I don’t consider the charges authorized by me. I had no idea what I was getting into. My co-pay for seeing a psychologist while on Medicare has been $zero, including in late last year. I don’t think I would’ve consented to such an evaluation had I known what I was in for financially and evaluation-wise. I put little stock in the opinion of someone who’s met a person only once. Letting the evaluation report stand is one thing, but paying so much money is now unacceptable to me for what I consider to be transactions I didn’t consent to with full knowledge. I had no expectation of a co-pay like that and had no chance to investigate before-hand any charges I might incur.

I’m writing you rather than him directly because of your role in the process to get your perspective, and my anger about the charges has returned. I don’t want to react in anger to him, but re: the charges, the report, and non-response to my report requests have left me that’s how I feel. Something went wrong with the process. I’m not sure what you knew of any of it, but my expectation was very different from what’s happened.

[sunrise]

It's a good letter, but somewhat long and complex. You keep your anger out, so that's good. I wonder if you can state clearly at the end what you would like to see happen--how you would like to see the matter resolved. For example, "I am willing to pay for the ADD test, but not the other tests" or "I would be willing to split the cost of this miscommunication with the therapist's office and pay half of the charges" or whatever it is you are hoping to get. And then ask pdoc his opinion on that plan or if he has other suggestions. That makes it easier for the pdoc to tell how he can help you.

[imapatient]

Yes, I have a problem with editing my thoughts as to what's important vs. not important enough to bring up when emotion is involved.

I guess I'm torn becasue I don't know quite what I want as far as paying--what's reasonable or not, and how to suggest a figure. Plus I'm trying to convey the story for the bigger goal of educating them that there were communication problems somewhere(s).

[sunrise]

imapatient, I did think the letter was really good. I just am used to busy people with short attention spans who don't read things carefully, so I am always trying to help the reader get the main points. Your letter is good, but will the reader's motivation to read the whole thing and understand be equally as good? Hopefully, the answer is yes!

If you don't have any idea how you want this to be resolved, perhaps just put something non-specific such as, "I would like the $260 charge to me to be adjusted since I didn't agree to these tests and wasn't informed in advance of their cost to me." Then see what they come up with. The key will be finding the right person to present your case to (in Billing? office manager? etc.) Hopefully, your pdoc can help with that.

Good luck!

[imapatient]

New version of my letter, advice appreciated.

Dr V & D

I’m writing about concerns relating to my session with Dr. D last November.

There was miscommunication or misunderstanding somewhere, and I’m left with a $260 bill that I had no expectation of incurring. The timeline:

Dr. Vreferred me to someone in the practice to evaluate me for ADD. The office later told me Medicare wouldn’t pay unless the tester had a PhD, so I was scheduled to see Dr. D. From Dr. V's comment I expected a computer test that takes about an hour. What I received was an approximate half-day evaluation of many sorts with a long interview, MMPI and other tests.

When I received the follow-up report, I was shocked that it dealt with so many issues and diagnoses—I thought it was an AD(H)D evaluation. I thought of submitting a response.

In late winter I received a bill that was unexpected—approximately $260. In trying to decide whether to write a response to the report and what to do about the bill and the whole matter, I thrice requested a copy—June, July. Sept.--of the report so I could go over the situation and decide what to do.

I finally decided to wash my hands of it and made a payment Sept (?) at Dr. V’s office that I was told included Dr. Da charge—the same billing co. is sued. Not so, as I’ve now received notices from a collection agency.

In re-thinking—as I had originally, hence my delay in paying—I don’t consider all the charges authorized by me. I expected the hour computer ADD test—not a half day. My co-pay for seeing a psychologist while on Medicare has been $zero, including last Dec. I don’t think I would’ve consented to that session had I known what I was in for financially and evaluation-wise. I went along that day, but without informed consent. I had no chance to check before-hand my co-pays.

I don’t where the breakdown was, but I’ve been charged for a type of visit I didn’t expect to have and for an amount I had no chance to know of in advance of that day. I don’t know what a fair resolution financially is, but I don’t think being charged the $260 amount is fair to me given the circumstances. Finances aside, there was a systemic breakdown that all should be aware of.

[(JD)]

It's still a good letter. I'm wondering if contacting the billing office of the T test-giver and reminding them that medicare is supposed to pay for this, since it was prescribed by an authorizing doctor.

Of course, only $260 for a half day is not expensive with the way billing goes. It could actually cost that per hour. Don't be surprised if this is, indeed, your co-pay.

You could contact medicare and ask questions over the phone, about what they pay and don't, and if there's a special process to go through for full payment.

In your letter above, do specifically say that you need the amount to be reduced, and anything the pdoc can do to make that happen would be appreciated.

[imapatient]

Well, Medicare did pay their part, what's left is what I owe. But I didn't sign-on for anything but the one test, so I don't think it's fair for me to be charged for what I didn't expect or know I was going to get. I would never place much faith in a one-shot full-blown evaluation of me from a stranger. It might happen all the time, but I don't buy into the validity of it. When I got the follow-up and was really confused on why it diagnosed me en masse rather than just ADD, there were all sorts of things in it that were erroneous objectively and, I think, subjectively. No stranger can understand my very complicated life and being in talking to me for a couple of hours. It's taken many, many sessions with therapists before they seemed to understand me--and that's what they've said, too. I left that idea out of the 2nd version.

My first inclination--and still, though muted--is to report all charges other than ADD charges as being unauthorized to, i.e. not even Medicare should've been charged.

[gardenergirl]

Originally Posted by imapatient

Well, Medicare did pay their part, what's left is what I owe. But I didn't sign-on for anything but the one test, so I don't think it's fair for me to be charged for what I didn't expect or know I was going to get. I would never place much faith in a one-shot full-blown evaluation of me from a stranger. It might happen all the time, but I don't buy into the validity of it. When I got the follow-up and was really confused on why it diagnosed me en masse rather than just ADD, there were all sorts of things in it that were erroneous objectively and, I think, subjectively. No stranger can understand my very complicated life and being in talking to me for a couple of hours. It's taken many, many sessions with therapists before they seemed to understand me--and that's what they've said, too. I left that idea out of the 2nd version.

My first inclination--and still, though muted--is to report all charges other than ADD charges as being unauthorized to, i.e. not even Medicare should've been charged.

Did the referring doctor use the word "test"? Or could it have been "assessment" or "evaluation"? What you describe is an appropriate battery of tests to assess someone for ADHD. Part of the criteria for diagnosis of ADHD is that the symptoms, if present, cannot be better explained by another disorder, hence the MMPI. I'm surprised the psychologist who performed the assessment didn't go over what would be involved in the assessment before you began. When I did this kind of work, it was detailed on the consent form, including the charges, though that was a different setting.

Still, I know that getting a bill like that when you didn't expect it is upsetting. And if the psychologist didn't go over the procedures in advance, I can certainly understand your upset.

I hope this works out well for you.

gg

[sunrise]

An assessment for ADHD does not have to include the MMPI. You don't have to have a whole battery of tests. Just the ADHD ones and some key questions and symptom assessment by a skilled interviewer is often sufficient. ADHD instruments often have embedded in them, questions to help with differential diagnosis (ADHD vs. depression, anxiety, etc.). I think sometimes psychologists can go overboard with their tests. Not getting your consent is a serious issue.

impatient, I agree with sky. Be sure to state very clearly in your new letter what you want to happen (bill reduced or dismissed, direction from pdoc on who to take your complaint to, etc.). It's a good letter, but not specific enough on the "action items" you want from people.

[imapatient]

Yes, I'm uncertain about the "action" issue. I feel guilty about asking for any cost reduction. But aside from the cost issue, I need to write something because the T and Pdoc need to know that there was a big communication failure.

There were no sort of consent forms to sign.

[sunrise]

For what they consider routine office procedures, there usually isn't a consent form. But they should verbally explain what procedures they will be doing to you and get your verbal OK.

[gardenergirl]

Originally Posted by sunrise

For what they consider routine office procedures, there usually isn't a consent form. But they should verbally explain what procedures they will be doing to you and get your verbal OK.

But if she saw that psychologist specifically for the assessment, they would need to obtain informed consent for the assessment--especially if there has been no prior relationship between them. This is whether performing ADHD assessments is routine or not for the office.

Also, while it's correct that the MMPI is not required for an ADHD assessment, it's not an inappropriate tool to use to rule out other diagnoses, particularly any axis II issues (I'm not saying that applies in this case, fyi.)

gg