Shah Associates, MD

Review: This past April, my wife [redacted] made an appointment for a new patient physical examination for both her and me with Dr. [redacted]. At the time, [redacted] clearly stated that the appointment was for a new patient physical and not an office visit. Annual physicals are covered 100% by our insurance plan, with no co-pay.

When we arrived at the office on April 16 for our appointment, we handed our health insurance cards to the receptionist – which clearly state that there is a $30 co-pay for office visits – and indicated again that we were there for our new patient physical. No co-pay was collected at the time, and no indication was given by either the receptionist or Dr. [redacted] that we were having anything other than a routine physical.

Several weeks later, we each received a bill for a $30 co-pay. Both the front-line billing department and [redacted] in billing indicated that the doctor’s office told them that we had an office visit, not a physical, even though neither my wife nor I was previously informed of this.

The staff also said that it is the practice of Shah Associates to have an office visit before completing a physical, something we weren’t informed of until we spoke with billing. (Dr. [redacted] said the reason for this is because a physical takes longer and people often cancel. To me, this indicates that Shah Associates is more interested in making money than providing top-notch care to its patients.)

In addition, both Dr. [redacted] and [redacted] told us that since we had several diagnoses recorded, our visits can’t be considered a physical. But of course, when visiting the doctor for the first time for what I presumed was a physical, I would notify her of all my chronic conditions – all of which had been diagnosed previously as part of a routine physical.

We understand that if Dr. [redacted] didn’t perform a physical, she can’t bill our insurance as such. We also now understand that it is Shah’s policy to do an office visit before a physical – something that is unique and therefore unexpected. However, there were at least two opportunities for Shah staff to inform us of this, and of the co-pays, before seeing the doctor: when making the initial appointment and when we checked-in at the office.

Due to the lack of transparency in Shah’s billing practice, I e-mailed Shah's COO, [redacted], on June 4 and June 11, 2013, asking him to waive the co-pays ($60 total). I haven't received response. We have the right to be informed consumers when making decisions about our health care; had we known there would be co-pays, we wouldn’t have proceeded with the doctor's visit.Desired Settlement: We would like the two $30 co-pays ($60 total) waived. (We haven't yet made any payments to Shah Associates.)

Consumer

Response: