Can a first year med student legally treat patients without direct Dr. oversight?

[DwayneEMTP]

During my recent tachycardia issues I went to an Urgent Care to get an ECG. I'd asked specifically if I'd be seeing a physician, as I wanted a physician level assessment, as was told that I would.

While waiting a young man came in an introduced himself as a medical student and asked if it was ok if he interviewed me while I waited for the doc. I said 'sure.' It was obvious that he had no real idea how to do such an interview, he kept checking a sheet of paper for further questions, but ended up asking only a half dozen or so. No touching of any kind was done. They did an ECG, and he then came back in an explained that he was confident that I was having anxiety issues and that I should try and relax, but not to worry about it. When he was leaving I said, "How far along are you in school?" He said, "Well, actually I'm just starting my second year of school." I'm not sure if that is medical school, or school in general.

He left, and then a girl came in and started to take my information, gave me a printout of my diagnosis, and then it occurred to me I wasn't in fact going to see the doc at all. I thought, "Well, screw it, I'll pay my hundred bucks and go to a different doctor." I'd asked about price before my appt and was told that they couldn't tell me specifically, and then after, that it couldn't be figured right then because of the ECG, that I would be billed. But I recently received my bill for $954.00.

I've never known an urgent care to charge so much, but $400 of that is a "new patient physician consult."

The next doctor I found did an actual assessment and ecg and discovered a dangerous medicine interaction that was most likely causing my tachycardia issues and could have been really dangerous if left undiscovered...

I'm guessing that this medical student doesn't have any legal level of certification, so I'm wondering, as I wait for my next phone call to fight my bill, if it's even legal for him to treat patients without direct oversight? And are there morals and ethics surrounding the doctor billing for his physician level services yet sending his medical student in instead, and only?

And lastly, has anyone EVER been billed a grand for a quick care/urgent care visit???

[Doczilla]

No, yes, and no.

A medical student does not have an MD degree, and therefore no license. They cannot bill. A first year RESIDENT (and that may be why they identified themselves as a student) can see and treat patients, but not independent of oversight by an attending (typically has to review each case directly, as well as any diagnostic adjuncts. Many don't necessarily see the patient themselves.). They also have no license until they have completed their first year of residency, Step 3 of the USMLE, and complete the state's licensing process.

Billing for this without being seen by a physician is fraud. Without a physical examination, you can't bill at that level either unless you are a psychologist. A level 5 coding requires examination of a certain number of body systems, history points to include medical, family, and social history, and a review of several body systems (ROS). Call the billing company and explain this, and they should write it off. If they push back, mention the fact that an actual doctor found it was due to a dangerous condition, and that should also make them lean toward writing it off.

What probably happened is that the doc probably got busy, staffed the patient with the student, then didn't see you though the medical student thought he did.

'zilla

[Arctickat]

Sorry bud, I can't speak to the legal issues, but I would be irked to be billed for a physician consult when I was never exposed to a physician. I'm sure that your bill will likely go away though when the Urgent Care Clinic is informed of the results from your second opinion.

Edit: 'Zilla's response came in as I was typing up mine. He seems to have good facts.

Edited December 3, 2012 by Arctickat

[Just Plain Ruff]

I already responded via facebook.

[spenac]

Just hope you are ok man. Hopefully they trash the bill.

[island emt]

First off Glad you discovered what was causing the problem

Second. I'g tell the urgent care clinic you were forwarding their invoice to the state attorney generals office for fraud investigation & maybe even the feds for violation of medical practice.

As a licensed Paramedic , you more than likely have more education and training than a first yr med student.

We gave you a better exam over the internet than they did for a grand.

My invoice in the amount of $300.00 will follow.

[island emt]

Next time you need a 12 lead done , stop by the local ambulance service and I'm sure they would be glad to provide a professional courtesy freebie.

[mikeymedic1984]

I would go get a copy of your medical records before they have a chance to alter them and add "Physician Notes" like he really saw you; then I would follow up with whatever regulatory body your state has to oversee Doctor's offices and hospitals. If such a thing exists ?As far as the bill, there are ambulance services that charge just as much to transport someone less than 10 miles. That's the american health care system, jack the price up 4 times what it should cost so that the people with insurance pay for the ones without insurance.

Edited December 4, 2012 by mikeymedic1984

[ERDoc]

I agree with what Zilla said. Medical students cannot legally bill, nor write the chart for billing purposes. In the 2 states I have practiced in, even with residents, and attending physician must see every patient (I'm pretty sure this is either and RRC requirement or possibly a CMS requirement). Is there an insurance company involved? If so, let them know. They love to not pay for things and this may trigger some form of investigation. Evey state also has a medical board that oversees the licensing of MD/DOs. You could contact them also.

[DwayneEMTP]

Thanks...not ignoring the thread but traveling back to work...

No insurance...it's under review...but I'm going to make it ugly if they don't play ball ...Thanks for all of your help...I'll update with a resolution...