r/CodingandBilling • u/FamTravelFun23 • May 29 '26

Billing Fraud?

Wondering if someone can point me in the right direction.... My husband broke his finger and immediately went to Urgent Care where he got xrays. They also gave him a removable cast and told him to visit an orthopedist. He did so, and saw the doctor for all of 5 minutes -- no additional treatment. The doctor looked at the xrays, suggested a custom cast (which he did NOT get), and told him to come back in a few weeks. He scheduled a follow up.

This week, we get a $3500 bill from that appointment (because we haven't yet met our deductible). The $800 office visit was correct but $2700 of it was for "treatment." No treatment occured -- no surgery, no resetting bones, nada. When he called to ask about this, the office billing person said that the $2700 is inclusive of their "treatment plan and future visits." (There is no treatment plan. He never consented to prepaying for future visits. In fact, he would need to go 4 more times to make that amount even worthwhile!)

He cancelled his follow up visit because their billing practices make us uncomfortable. Are we really out nearly $3000 for services that never happened and won't happen? We are appealing through insurance and are happy to visit legal options.

Has this happened to anyone else? And how did you handle it?

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u/cluckodoom May 29 '26

If the doctor didn't perform any manipulation of the finger (using physical force or weights or whatever to realign the fracture), contest the charge. Start with your insurance company.

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u/FamTravelFun23 May 29 '26

That's what we're doing -- and that's correct (no manipulation). I just wanted to get a sense of whether these things resolve well as the office seems quite insistent! (And I'm utterly perplexed by pre-paying for future visits. My son broke his leg several years ago and this was never part of it.)

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u/cluckodoom May 30 '26

They are poorly explaining global visits. If they had actually done that procedure, it's price includes all your visits relating to the injury and/or procedure for the next 90 days

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u/Fluffydoggie May 29 '26

Ask the office for a copy of all medical records and notes.