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You wrote, Another thing about medical debt is that it isn't always what it seems. My Mom was in the hospital a number of years ago, and we started getting bills from doctors we never even heard of for vague services. I tried to challenge the business office, asking them to tell me what services the doctor provided and was ignored and ultimately sent to collection. I helped Mom formally challenge the bill using her rights under the Fair Debt Collection Practices Act, asking for documentation. Guess what? They couldn't provide any, we never heard from them again, and there was no impact to her credit rating.

I've been stung by the "not in network" issue before. Most PPOs will do something they call a "wrap" where if you've made a good faith effort to get an in-plan surgeon and hospital, they'll cover things like the anesthesiology. They won't always do it though unless you call and escalate your complaint.

However, I've been leery about being successful at getting the insurance company to do a wrap even though I've managed it a couple of time. So for non-emergency procedures, I've always:

1. Asked a written estimate from the surgeon / physician.
2. Asked for a list of hospitals he'll work at and select the hospital from the in-plan list.
3. Asked for a list of other physicians, specialists, anesthesiology or independent technicians that need to be scheduled.
4. Selected and scheduled everyone myself.

This has only failed me once. (At least once I started doing it. And you might be surprised how many time my ex and I have been in the hospital, even though I'm fairly healthy.)

In that one case (back in the '90s), my ex was having her gall bladder removed. Another surgeon scrubbed in without consulting with me. When I confronted the surgeon, he said the operation went smoothly and was routine. In fact, he finished a full hour ahead of schedule. I then asked him if this would make any difference on what his office billed for the procedure. He said no. (His office had already quoted a figure to me in writing.)

I then wrote the second surgeon's office and copied my insurer and accused the surgeon of fraud - outlining my case, telling the insurer I have no intention of paying this bill and the insurer shouldn't either, and that if I see another demand for payment I'd take the doctor to small claims court.

It worked. I never heard from that doctor's office again.

Of course I wouldn't recommend you threaten a doctor with litigation - at least not unless you are serious. And I'm not saying you'll always win such a case either. But I think if the doctor has no good basis for a claim and you tell them and your insurer why you think it's fraud, I think there is a fair chance they'll back down ... even before the bill is sent to collections.

- Joel
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