Stanton S. Lebouitz

March 14, 2016Dear [redacted],As I responded to you last week, [redacted] came in to see me to examine two moles that were irregularly shaped. Because of their shape I told him it was necessary to have them removed and sent to pathology. There was a happy ending, both moles were found to be non-cancerous! I told [redacted] that the removal was deemed necessary and is a covered service from his insurance, [redacted]. A covered expense is not the same, as your insurance company will pay the entire bill that I would never have told him. It's insurance jargon, it means they will cover that procedure, but if you have a deductible it means that the patient will pay the deductible and the insurance pays the rest. This is explained in the following documents that are enclosed that the patient said that he wasn't aware but he signed and read them.I am enclosing three very important papers that were signed by [redacted] prior to having the procedure done:1. Our financial policy where [redacted] signed on 8-31-15 that he Held financially responsibility.2. Our Advance Beneficiary Notice of Non-Coverage (ABN) where [redacted] signed, again on 8-31-15 the day of surgery also stating that he should be aware that he is responsible for the service.Numbers 1. And 2. explain in detail what covered and deductible means in insurance jargon clearly stating that we will never go between you and your insurance company. I said the surgery that needed done was covered, not that his insurance company would pay the entire bill, clearly a difference.3. The pathology permission form dated 8-31-15 stating that [redacted] gave permission for Dr. Lebouitz to remove the questionable lesions and4. Paperwork from [redacted], where his specimens were sent to Pathology showing that they do participate with [redacted] insurance.I wonder what would've happened if the lesions were not removed and later they were found to be MelanomasI cannot believe that in this day and age, [redacted] doesn't understand that along with his insurance he will still owe co pays and deductibles. This info is clearly on the papers I submitted with this letter.I am requesting that [redacted] produce a copy of his insurance policy and a statement ending on 12-31-15 from his [redacted] insurance, showing all the medical bills he had to pay in the year 2015. In this situation pathology got the remainder of his deductible and paid almost all of my surgical bills.All of this info about the insurance was on the papers, co pays, deductibles and covered expense was on the financial policy, again that he, prior to the procedure signed. [redacted] could've said to me after reading our financial policy that he wanted to think about it, take it home, check with his insurance company and reschedule in another week or two. I would've had no problem with that.Sincerely,Stanton S. Lebouitz, M.D

March 2, 2016Dear [redacted],I am in receipt of your letter regarding the above-mentioned complaint. After extensive investigation the bottom line is that what [redacted] is complaining about paying was his deductible to the laboratory for his pathology charges. We actually called [redacted] Hospital...

billing and they reviewed this with their Network. The charge was actually his deductible, which I would have no way of knowing and he never told me. They do accept [redacted]'s insurance, [redacted].His insurance covered everything we billed minus his $20.00 co pay and that is all he paid us.He had signed paperwork stating that he would be responsible for any lab charges (a copy is attached), [redacted] does participate with his insurance company, [redacted] and they did pay, minus his deductible the charge from the lab.As for me telling him he would have no fees since it was my recommendation is ludicrous! I would have told him that this procedure would be sent off to his insurance since we participate as well as the pathology lab. I would have no idea how much the lab charges, but I have no choice but to send the specimen to pathology. In his words, the moles were irregular in appearance and had to rule out skin cancer. And in fact the insurance did cover the cost to him except unknowingly he had a deductible which only he would've known.We spoke with the lab who shared with us that [redacted] had to pay them $677.88 plus the $20.00 he paid us equals $702.88, not sure where he got $850.00?In summary, the insurance did cover his expenses, except unknowingly this gentleman had a deductible which only he would've known about and would've had to have paid no matter where he went to have it removed and to be sent off to pathology.Sincerely,Stanton S. Lebouitz, M.D.

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
It is unfortunate that Dr. Lebouitz chooses to ignore the financial damage that HE has caused me.  He says I could have told him I needed to take time and think about the procedure, but I was not given that opportunity.  As the medical professional with significantly more experience than myself in the procedures revolving around his profession, he assured me that I would not have to worry about any significant costs associated with the procedure he recommended.  This resulted in bills that I was neither expecting or in a position to handle and that could have been avoided without his misdirection.  He led me to believe that I had nothing to worry about, leaving out the fact that the pathology was a completely independent institution with outside costs that would not be included in his statement that it would be covered.  I was a laymen asking a professional about the potential costs I would incur and he completely misled me.  Even if unintentional and with my best interest at heart, he still misled me.  He put me into a situation where I could not make an accurate financial decision.  As a medical professional I looked to for guidance, he should take accountability for the financial burden he put on me and learn from this experience to make sure he does not mislead other patients that seek his expertise, no matter how good his intentions may be.
Regards,
[redacted]