5 On Your Side

Broken Pinkie, Doctor Visit Leads To Insurance Hassle

Posted July 11, 2005

— Most people have received statements in the mail from insurance companies that show what was and was not covered on a recent doctor's visit. It is easy to not pay attention to them when we do not owe anything. One woman said she is concerned her insurance company paid for a doctor's service she said she did not receive.

Tonya Register went to see Dr. Jon Kolkin at Raleigh Hand Center and found that her pinkie finger was broken.

"He said, you know, he felt like surgery was the best thing for it, and I just said I don't want to do that. You know I know there is going to be a lot of pain involved, a lot of money involved, so what's the alternative," Register said.

The alternative was a splint, so that is what Register got. She then received a benefits statement from Blue Cross/Blue Shield: Her office visit was $150, supplies cost $33, radiology cost $74 and surgery was $368. The problem was Register never had surgery.

"I couldn't believe that he would charge me for something I hadn't had," she said.

Register called Raleigh Hand Center's insurance representative.

"She said that surgery is coded the same way as a broken finger," she said. "Then she told me, 'Well, that was in case you have surgery in the future. I said, "You don't charge people for having surgery, maybe."

Register decided to call Five on Your Side. Five On Your Side met with Dr. Jon Kolkin, who read from a prepared statement.

"Unfortunately, quality treatment in this situation often requires multiple visits to the doctor. So under these circumstances, I was hoping to save her some money by just doing a one-time called a global or all-inclusive fee," Kolkin said.

Kolkin told Five On Your Side the charge covers unlimited follow-up visits for 90 days.

When asked whether the charge was for anything she had already had done, Kolkin responded, "I really can't get into any more details. I've really told you everything I can that I think is reasonable in this short period of time."

When asked again whether anything done so far would merit that charge, he replied, "I have nothing further to say, but thank you for coming by."

Five On Your Side also called Blue Cross Blue Shield. A representative said the surgery code can also be used for "manipulation type procedures" and added, "There's nothing amiss with this claim."

Register disagrees and said the bill for her broken finger is just another example of a health care system that also needs a fix.

"If it's happened to me, it's happening to a lot of people and I feel like that's probably why insurance rates are so high," she said.

Register was scheduled for one follow-up appointment, but cancelled after her discussions with the office about the charges. Also, both Blue Cross Blue Shield and Dr. Kolkin say the way Register was billed is standard practice. Register thinks that needs to change.

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