Medical Malpractice Insurance coding

[ellencho11]

I have a more thorough explanation of my claim under Trial/ Bill of Particulars, but briefly, I had a scheduled routine visit with my ob/gyn and at the end she ordered blood work to test for things that seemed normal for a rountine exam to me, but without telling me, she coded them as diagnostic. I was billed $200 for these tests...my visit should have been covered at 100%, and when I appealed it, the insurance company said that if she would change the coding to include them, they would cover them as part of the routine visit, but the doctor refused to change the code.
I took her to small claims, then she sent a lawyer, and I wrote a bill of particulars, explaining why I should be refunded the money for these tests, and sent it to him. We now have a trial date set. He has said that this constitutes a malpractice case and I must comply with Va. Code 8.01-20.1 "certification of expert witness opinion at time of service process. We were the only 2 in the room at the time she ordered the tests...they were not included as part of my scheduled routine exam, they were not requested by me, and she did not inform me that they would be billed separately or that she ( the doctor)did not consider them part of the routine exam. I am confused as to what the lawyer is requesting. I have to send him something within 10 days. Thanks for any possible help you can give.

 

[ellencho11]

Va. Code 8.01-20.1 ?? HELP !

Can someone let me know either way, if there is or is not something preventing doctors from ordering unnecessary tests, etc . I posted something, and can't tell if no one has replied because they just haven't or because there is no such regulation .

Also, I was sent by my doctor's lawyera note that I needed to comply with Va. Code 8.01-20.1 concerning expert witnesses. It is written, of course , in legal jargon. If someone is familiar with this , could you translate it into common english please. I can use all the help I can get at this point. Thanks so much.

 

[Michael Wechsler]

Wow... this is a lot to go through for a small claims case. Have you discussed with the insurance company whether the tests you received were coded properly? What the other attorney is saying is that if you are claiming that the doctor put in the wrong code and should have used another, then you need to have a medical expert who would know about whether such a coding was done incorrectly testify. Are you qualified to make such a statement that the code was not correct? Perhaps not.

It seems that you should also investigate whether the doctor had an obligation to tell you that the tests you would be taking might not be covered under the insurance. I'm not sure if the other lawyer is right and in small claims I'm more inclined to believe that the formality the lawyer seeks may not be necessary and, if you don't provide it, then the court can adjourn the case and allow you the time to get them over what they are requesting - which is the testimony of a medical expert who will say that the code the doctor entered wasn't the proper code. Good luck.

 

[ellencho11]

First...thanks so much for replying. I am not claiming that she put the wrong code. My complaint is that I was there for my yearly check-up. She sent me for blood work that she did not consider as part of that and knew that it would be treated differently for billing.
I didnt ask her to check my blood work, she wrote the order and sent me down to the lab. I went willingly, because I knew that my insurance paid for this at 100 %.
My complaint is that she did not tell me that the blood work I was going to the lab to get, was not part of my yearly check-up. That she considered them to be diagnostic, and would be billed differently. It is the omission of information in order for me to make a choice as to whether I wanted to have the lab work done. If I had known they would be billed differently, I could have called my insurance company, asked if and how they would be covered. If at that point they told me they would cost about $200, I know I would have opted not to have them done...she wasnt checking for cancer, or some life-threatening disease. Bottom line....by withholding information, the decision to spend my money was hers, not mine.
Also...I understand I have to respond to his pleading for an expert witness. It states that I can decide one is not necessary, which I belive it is not . My question also is, is there some legal format that I must follow when writing and sending this answer. Does it have to be notarized, or have special wording, etc.
THANKS again so much....I had no intention of making such a big deal about this. I tried to talk to her on the phone many times.I tried calling and left messages for her when I would talk to her claims clerk trying to sort this out for over 4 months. When she finally did call...she was very angry that I had questioned her at all, and thought the whole thing was ridiculous. I thought I could just go to small claims and get my $200 back. She sent a lawyer...which I am sure cost much more than that, and the whole thing is now a mess. I would have settled for half of it, if she would have just talked to me on the phone and tried to work it out. It makes me wonder how many other patients she has done this with, and they didnt notice.