Medical Bills You Shouldn't Pay

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Neurosurgeon McKalip says doctors can be trusted not to gouge the poor Ben Van Hook

Illustrations by David Foster

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Quest Diagnostics, the country's largest lab chain, with revenue last year of $6.7 billion, has faced investigations and lawsuits over allegations of balance billing. A private suit that seeks class-action status in federal court in Newark, N.J., alleges that Quest has balance-billed thousands of patients covered by private insurance and Medicare, turning over many accounts to debt collectors. Quest, based in Madison, N.J., denies any wrongdoing.

In a separate case in 2003, the New York Attorney General's Office alleged that Quest encouraged consumers to overpay or billed them after Quest had already been paid by insurers. The company denied wrongdoing in the New York case and said only five people were due modest refunds. Quest agreed to pay New York $150,000 in legal costs and revise some practices, such as waiting longer to dun patients while a claim is pending with an insurer. A Quest spokeswoman says: "The vast majority of our transactions occur problem-free when correct information is provided by patients, physicians, and payers."

As some authorities get tougher, physicians are trying to overturn prohibitions on balance billing. The American Medical Assn. is lobbying Congress to allow balance billing within the Medicare program, as was allowed until 1991. Two Republican congressmen, Tom Feeney of Florida and Tom Price of Georgia, have sponsored legislation that would accomplish that goal. The AMA cites declining reimbursements from Medicare and private insurers in support of its bid to bill patients directly. AMA member David McKalip, a neurosurgeon in St. Petersburg, Fla., says patients can trust doctors to behave ethically and not gouge the poor: "Doctors will know up front which patients are willing to pay" beyond what the government reimburses.

FIGHTING BACK

Consumers overwhelmed by medical bills might dispute that. Many lack the resources to fight balance billing on their own. With an eye on their legal fees, private attorneys hesitate to take on individual disputes over amounts that usually don't exceed $1,000. Glenn Siglinger is one exception. He fought a lengthy battle against a surgeon all the way to the Connecticut Supreme Court. In 2006 that court upheld a trial verdict awarding the Siglinger family nearly $40,000 in punitive damages from a doctor.

The case began in December 1995, when Siglinger's wife, Laura, and his daughter, Allison, then three, were injured in a car accident. Both were taken to the emergency room at Bridgeport Hospital, where Dr. Charles Gianetti, the plastic surgeon on call, stitched a cut on Allison's face. The Siglingers' insurer paid Gianetti $1,981 under a contract with the family's health plan. Later in 1996, he claimed the Siglingers owed him an unpaid balance of $4,496. The Siglingers refused to pay, and Gianetti sued them. Ruling for the Siglingers, the trial judge ordered Gianetti to pay their legal fees, in addition to the punitive damages. The Siglingers say he hasn't paid them anything.

"It was traumatic enough seeing my daughter go through a serious accident, but then to go through this," says Siglinger, a real estate investor. He and his wife have since divorced; Allison is now 15. "I wonder how many people paid these bills without giving it a second thought," he says. The Siglingers are among 150 patients Gianetti has sued for unpaid balances, according to state records. The Connecticut Attorney General's Office is scheduled to go to trial next year against Gianetti, having accused him in a civil suit of improper billing.

Gianetti, 69, no longer practices medicine, but he continues to pursue former patients in court. He says the state of Connecticut has "nothing on me," declining other comment.