Legal Question in Consumer Law in California

I was diagnosed by my doctor with reflux and prescribed omeprazole, which i could not tolerate. I called and they prescribed something else the insurance co. denied. I called back to ask what to do next, and they said they'd get back to me. Six months later, I had not heard, and called again. They asked me how the Nexium worked out - i said I had never been prescribed Nexium. They said it had been prescribed. So I asked if they could call it in and I'd pick it up but they demanded I make an appointment. At the apptmt, the NP asked why i was there and I explained I needed to pick up the prescription for Nexium. She looked embarrassed, asked what my symptoms were and told me the prescription would be phoned in to the pharmacy. I was charged $278 for this appointment of less than 5 min. Since the condition cannot be diagnosed or reviewed by an exam, this could have been a phone call. I do not believe $278 is commensurate with the appointment type. I called the office but they refused to discuss it. I went to the patient advocate who had no success. I filed a grievance with the insurance co. who said I was responsible to pay it. What are my options now? I would like to fight this to the end, and because the stress over this bill has aggravated my condition immeasurably, I would like personal compensation as well.


Asked on 11/27/10, 12:16 pm

1 Answer from Attorneys

Asaph Abrams Law Office of Asaph Abrams

I will leave it to other colleagues to consider the viability of a claim or contest. However, if you had been waiting for an answer on the next step, why did you wait six months to follow up on the matter? It's conceivable that a subsequent in-office appointment was required due to that passage of time, which was avoidable. It is apparent after even a day's delay that a request may not have been handled. And even if its handling is pending, it does not hurt to follow up after a day to convey one's sense of urgency. The squeaky wheel gets the grease. It is not excusable, but it can happen that a medical provider may fail to get back to you: they are not experiencing the same sense of personal urgency that the patient has. We must ensure our own welfare through assiduous follow-up. Just don't squeak too much when it's obvious that the matter is being handled as quickly as possible. I write this simply to encourage both patients and consumers to advocate their own interests. Let's keep in mind: notwithstanding the greatest degree of diligence, business, health and other transactions can be inherently frustrating and time consuming. Expect missteps and be pleasantly surprised with success. To the current crux of the matter, I'll reiterate that I won't address the issue of fighting and compensation. But in the scheme of things, and notwithstanding your personal hardship, $278 is not an earth-shattering amount. Even if 5 minutes doesn't seem like much, offices incur related costs of overhead, insurance, and responsibility. Without covering costs, the provider cannot provide to anyone. It is reasonable to be wise and not right. While yours truly will fight for his clients notwithstanding the amount in question, sometimes it's just prudent for the non-represented individual to pay under protest and move on. We owe it to ourselves to reduce stress and I wish you good health: it's the most important thing of all. Now, forgive me, I'll step off the soapbox and as always, I will timely return all of my clients' calls and emails.

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Answered on 12/02/10, 12:40 pm


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