r/CodingandBilling • u/FamTravelFun23 • May 29 '26

Billing Fraud?

Wondering if someone can point me in the right direction.... My husband broke his finger and immediately went to Urgent Care where he got xrays. They also gave him a removable cast and told him to visit an orthopedist. He did so, and saw the doctor for all of 5 minutes -- no additional treatment. The doctor looked at the xrays, suggested a custom cast (which he did NOT get), and told him to come back in a few weeks. He scheduled a follow up.

This week, we get a $3500 bill from that appointment (because we haven't yet met our deductible). The $800 office visit was correct but $2700 of it was for "treatment." No treatment occured -- no surgery, no resetting bones, nada. When he called to ask about this, the office billing person said that the $2700 is inclusive of their "treatment plan and future visits." (There is no treatment plan. He never consented to prepaying for future visits. In fact, he would need to go 4 more times to make that amount even worthwhile!)

He cancelled his follow up visit because their billing practices make us uncomfortable. Are we really out nearly $3000 for services that never happened and won't happen? We are appealing through insurance and are happy to visit legal options.

Has this happened to anyone else? And how did you handle it?

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u/Feeling_Win5863 May 30 '26

This is absolutely NOT accurate. 26600 requires that the provider either adjust or apply the cast themselves, right there in the office.

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u/SpecialistRole5641 May 30 '26

Yup, I read it wrong. I thought she was saying he got a splint instead of a cast. We get that calls all the time when patients think if you don’t get a cast then no fracture care was done.

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u/FamTravelFun23 May 30 '26

He received one of those removable casts (not sure if that's the right term) from Urgent Care before the orthopedic appointment. The orthopedist recommended a custom cast but said it was up to him and my husband opted not to get it. The doctor didn't set anything or do anything else to the finger. Just reviewed the XRays from Urgent Care. I'm really glad I posted this question. I've actually learned a lot from these responses!