Should a doctor inform me of prices before procedures?

General Questions
#1

I recently had a wart removed. I called around and most dermatologists were charging $35-$40, but instead I got a referral from my doctor (since insurance would cover it this way). I had to delay the appointment and in that time the new insurance year started - and so did my $100 a year deductible.

The dermatoligist I visited charged $77 and I only found out afterwards my insurance wouldn’t cover it (due to being under deductible). I’ve been billed by the doctor but the thing is I never agreed to pay this price for the procedure, and I never signed anything beforehand saying “go ahead and charge me whatever you wish”; in fact, I never saw or signed anything relating to fees the entire visit. I think it’s a case of the doctor charging a ton since insurance pays for everything nowadays, and if I had known his rates I would have gone to a doctor who charges only $35 for the same procedure. Is the doctor required to inform me of prices beforehand, and shouldn’t I have to agree to a price before a procedure is performed? Or do I have no case?

#2

It’s common for doctors to do this. I worked in a dentist’s office where it was standard procedure to avoid mentioning prices until it was too late, and I’ve encountered it with doctors as a patient. I’m pretty sure it’s legal, too, or it wouldn’t be so common. Er, this is in New Mexico; other states might be different.

(IMHO, it’s unethical in non-emergency situations.)

#3

Dunno if you have a case. What odd about your story, though, is that cost was important enough to you that you “called around” to get wart removal price quotes. But then you didn’t ask the Doc you went to what you’d be charged?

FWIW, there are different techniques for wart treatment. The given procedure is tailored to a given clinical situation as well as the preferences of the practitioner. I bet that in addition to provider to provider variation in price, you’d find procedure to procedure variation. Now I’m not advocating for one procedure over another. Wart treatment is one of those things that’s more art than science.

Have you tried talking to the billing manager of the office to see if you could work something out?

Choosy (budding dermatologist)

#4

In most cases you will sign a statement that you agree to pay whatever your insurance doesn’t cover. This was probably in small print on the sheet you filled out at the beginning where you listed your address, medical conditions, current problem, etc. If you never signed any such thing, you may legally have a case.

As a practical matter, however, if cost is a concern, you should make it known up front, and you may then be able to veto each proposed treatment on the basis of its charge.

It’s not usually a sinister scheme to screw you out of money. Rather, the office staff can’t guarantee what the doctor may decide to do, or whether something much pricier may be found during the examination/treatment. The doctor is generally much more interested in treating the patient rather than quibbling over the bill, which he/she may not be qualified to discuss anyway, depending on the complexity of your insurance plan. But if they tell you before you are seen that your wart will be $77 to remove, and then it turns out you have a skin cancer that will require repeated expensive treatments to remove, they’ve misled you, and put their foot in their mouth before knowing all the facts.

This may or may not be the way it should work in an ideal world, but such is life.

#5

Well I called around because I didn’t want to have to go through the month-long referral process (get an appointment with my school doctor, get the referral, make the appointment, wait 3 weeks to see the dermatologist) so I wanted to compare prices since I’d be paying the bill. But my insurance covered it so I decided to wait the month. Due to an unscheduled trip at work I had to postpone the doctor’s visit and the new school year started, resetting my deductible. I’m going to call the office to see what they say, but wanted to know first if I have a chance in a bill reduction.

My wife (almost done with Optometry school) told me this same thing. And while I probably signed this, I didn’t agree to be overcharged. I mean, when I take my car in to the shop the mechanic always calls with a quote first. When I buy something at the store I know the price right then and there, not a month later when I get the bill. My wife also told me they tell their patients right up front what their charges will be if it’s not going to be covered by insurance. I just think this is unfair business practices to do otherwise.

#6

This may not always be followed, but it seems like a fair expectation for those things that are usually not covered by insurance.

However, as I understood your example, your treatment is covered by your insurance, but you simply haven’t met your deductible yet. You can’t expect the dermatologist’s office to know this. Had they known insurance wouldn’t cover it, they probably would have asked for your payment that day, rather than having to track it down later by billing you.

Hopefully they’ll cut you a break on the amount. Politeness is probably key, and from this thread it sounds like you’ll do well.

#7

As pointed out above, the procedure involved in this instance isn’t necessarily the same procedure you got telephone quotes for. Regardles, some businesses charge more than others for comparable goods or services. Being more expensive than one’s competitors is necessarily overcharging.

My experience with medical practioners is that they generally don’t make a point of stating the prices for what they’re doing. Sorry to say, but it strikes me as rather naive – particular for someone with a family member in the health arena – to expect otherwise. Now, they will gladly answer any questions about costs, and the time to ask those questions – in any transaction in any field – is BEFORE costs are incurred.

It’s like going into a restaurant that doesn’t have prices printed on the menu, ordering and eating a meal, and THEN complaining that the prices were higher than expected and the waiter should have told you the price because, after all, other restaurants have prices on the menu. The failure to ask for information that one deems important until it’s too late to effectively use that information strikes me as an abdication of one’s personal responsibility to look after his own interests.

I don’t know whether or not your position has legal merit, but common sense-wise I believe it’s pretty weak.

#8

You have a $100 deductible. Your insurance will pay NOTHING until you have used up your deductible. If this visit didn’t use it up, the next gets taken out of it too. What difference does it make how much THIS visit cost? Unless this is the last time you see a doctor this year, you’re paying $100, regardless.

#9

That’s something I’ve thought about, but there’s 3 reasons I’m still curious about my options -

  1. I only went to the doctor twice in the last year - both times was for the wart. I don’t get sick too often.
  2. Even once I reach the $100 mark I still pay 15% of each visit.
  3. It’s the principle - I don’t like to be overcharged or taken advantage of (which may or may not be the case here), especially when I’m not forewarned of the price. I have arguments with my wife about this - optometrists charge $8 to remove an eyelash! A single eyelash!!! I would definitely want to be warned before having that done. The vet tried this with me once too, they clipped my cat’s nails for free once, but the next time there was a $10 charge (without informing me). It seems like a common practice as quothz said, and I just wanted to know the legality of it.