Doctor admits to intentionally misleading patients about health insurance

Close up of a medical insurance form with stethoscope

Imagine being told that your doctor accepts your health insurance, only to discover you have been stuck with a hefty medical bill at the visit’s end.

That’s exactly what happened to numerous patients of podiatrist John Lanham in Milwaukee, Wis. As a result, Lanham has been the subject of more complaints to state regulators within the past five years than any other foot doctor in the state, the Milwaukee-Wisconsin Journal Sentinel reported.

Lanham maintains that he doesn’t outright lie to his patients.  He simply tells them he accepts their insurance, but doesn’t explain the situation further.  Then, he sticks them with significantly larger bills than if he were in the patients’ network.

Lanham said it’s the only way he can stay in business, because patients would leave if they knew they were not in his network.  He also claims he’s certain that no judge will legally be able to force him to disclose this information.

“I unfortunately have to survive on patients’ ignorance,” Lanham told the Journal Sentinel.

Up to 92 complaints against Lanham have been filed with the Wisconsin Department of Safety and Professional Service since 2001.

Mary-Iris Taylor told the Journal Sentinel that she took her daughter to Lanham’s office to treat an ingrown toenail, believing she was in his network.  A couple months after the visit, Taylor received a $6,000 bill for the treatment – care she said would have only cost $200 in copays with an in-network doctor.

While Taylor hasn’t made a formal complaint, she did hire a lawyer to dispute the bill.  Lanham cut the bill down to $4,000.

“He’s basically doing this because he can get away with it,” Taylor told the Journal Sentinel.  “I don’t know how he can sleep at night.”

Lanham said he bases his fees on reimbursement rates accepted by Medicare and other major health insurance companies.  He will also determine the highest amount of money insurance companies will reimburse for different services – and uses that to determine his standard for pricing.

At the advice of his attorney, Lanham has since become somewhat more transparent when discussing insurance with patients.

Click for more from the Journal Sentinel.