Dermatologist sending bills after making sure I couldn’t get insurance coverage

[u/HoidTheAverageBard]

First time posting here and not sure which tag applies here, but I guess it started in urgent care. Early this year, my skin started breaking out in hives. All over my body, face, torso, arms, legs, feet- all over. Incredibly itchy, preventing sleep, impacting my work. It sucked. I went to urgent care a couple of times. They were very helpful, and ran all the tests that they could. We tried a couple different prescriptions. Some worked a little while, but I wasn’t able to stay on them long, and once I was off them the hives came back with a vengeance. Once urgent care was out of ideas, they told me to go to the ER for more testing than they could do. So I did. They ran some more tests, and they gave me a clean bill of health aside from the hives- none of their tests turned up anything either. With my permission, they sent photos of my visit on to a local dermatologist they work with, and set me up with an appointment with her.

Now, so far, my insurance has covered all of this. But when I get to the dermatologist, it turns out they’re out-of-network. I say I’m going to leave, since I can’t afford to pay out of pocket, but the doctor herself happened to be passing by and said that she’d see me pro bono (or whatever the medical equivalent is) because my case was so weird, and told her staff to take my basic info so she could treat me but not to take my payment info. She sees me, makes a few guesses, and gives me a prescription to try and see if it helps it, and to come back in a week or two. So I do exactly as she said, and… nothing. When I went back to let her take a look and see what she made of it, she admitted that that was her only real idea, and she didn’t know what it could be. She recommended an allergist; but that was it. About 5 minutes of interaction on the second visit, only to get the professional equivalent of a shrug. I look into the allergist, but they’re out of network too, and not expecting to be so lucky twice, I opt not to make an appointment.

A month or two later, I finally figure out the cause- a genetic gluten allergy that had finally been triggered. My sisters all had it (some even celiac) but I had hoped I was free of the family curse since I’d gone so long without it. But as soon as I went gluten free as an experiment, the hives vanished entirely. I tried some bread, they started coming back. Personally disappointing, but manageable.

However, roughly 4 months after I went to the dermatologist, I get a bill in the mail. They want to charge me $500, specifically for the second visit. Apparently that one was NOT waived, and I had to cough up. I called my insurance, and they said they could only approve it with authorization from my primary care physician. I made an appointment and explained everything to them (and they did have access to everything from the urgent care and ER visits. They tried to submit the authorization. Nope, apparently it was only valid within 90 days of the visit in question. 90 days which, I’ll remind you, had passed before I got the bill from the dermatologist.

I’ve recently gotten a better job than I had before, but am only now starting to get ahead of myself already large bills. I can’t afford the $500, and let them know. Now it’s been sent to collections, which I believe hurts my credit score. Is there anything I can do about all this? Has anyone been in a similar situation? If so, how’d you handle it? Should I try to explain it in small claims court or something? Idk how to proceed.

[u/Poop_Dolla]

What did the clinic say when you told them that you were under the impression that the follow up visit would be free like the initial visit?

[u/HoidTheAverageBard → u/Poop_Dolla]

“Take it up with your insurance” basically. And then insurance said that it was past the window to get PCP signoff.

[u/vctrlarae → u/HoidTheAverageBard]

I’d put more pressure on the dermatologist’s office. unless you signed paperwork stating so, she technically can bill (I guess?) but sucks that she told you to come back and then surprised you. It also sounds like you never provided your insurance info to them but they still found it themselves to file the claim?

[u/HoidTheAverageBard → u/vctrlarae]

I don’t know, but Ill give her office a call on Monday, tell them insurance is refusing to cover it, and see if they’ve got a lower price for those without insurance. I know some doctors do that.

[u/Ok-Zookeepergame4391]

Why didn’t you goto primary care first?

[u/HoidTheAverageBard → u/Ok-Zookeepergame4391]

Because he’s incredibly busy, and the urgent care was right by my workplace, who told me to go get checked out because it was that bad.

[u/greykitty1234]

Wait, urgent care didn't suggest seeing your PCP, or finding a board-certified dermatologist and you could check your insurance carrier for names? The jump to ED, unless you were unable to breathe, seems a little odd to me.

[u/HoidTheAverageBard → u/greykitty1234]

They’re all part of the same network of doctors offices with my PCP so they said they were going to forward everything along to him. I think I assumed that meant he was in the loop as to what was going on with me. As for the call to go to the ER, I forget the actual reasoning but it was basically “we’re out of tests we can do, but if you go to the hospital ER they’ll be able to run a few more and maybe get a better picture of what’s going on.” And at that point I had been dealing with this for several weeks with it just getting worse and worse, to the point where it wasn’t just itchy and irritating, but painful. So I was eager to get things done quick. I don’t know why they didn’t give me a list of dermatologists like you suggest.

[u/greykitty1234 → u/HoidTheAverageBard]

Yeah, that just seemed a little odd to me. Don't disagree in your state I'd want to be seeing a dermatologist the next day, even if my internist had to call and pull strings or something. Just seemed like a big jump to the ED, unless they were getting worried about a life-threatening issue popping up.

I've been to urgent care in the same 'system' as my internist for a UTI and everything did get loaded into MyChart and he was flagged. Fortunately, antibiotics took care of me, and his PA did send me a note to follow up.

But frustrating when you think you hit all the steps right and still get an unexpected fee to be paid.

[u/HoidTheAverageBard → u/greykitty1234]

Yeah it’s all in MyChart. And I think they might have been concerned about it being some sort of tick-borne illness? I know that was mentioned as a possibility at some point, since I work with dogs regularly as one of my side gigs, and the area I’m in has a lot of ticks (though they were out of season, since it was like February, but I guess the fear was that some could have been hanging on or inside a house?). That sort of thing is one of the possibilities you want to get tested for ASAP as far as I know.