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The Jewish Ethicist - Hidden Consultation

The Jewish Ethicist - Hidden Consultation

My chiropractor billed me separately for a consultation.


Q.I went to a chiropractor for routine treatment, but when I got the bill I saw he also charged me separately for a consultation! He never told me that he was providing a "consultation" or that I would be billed for his advice. What should I do?

A. In English, the legal term for benefiting from a service without paying for it is "unjust enrichment". But as your letter reminds us, sometimes we suspect that the enrichment of the service provider is equally unjust.

Fundamentally, the obligation to pay a worker in Jewish law stems from the service provided, and not from the agreement to pay. The Talmud tells us that if a worker enters someone's field even without permission and plants it, the worker is entitled to payment for his efforts. (1)

However, this obligation is obviously subject to certain restrictions. A field owner is not at the mercy of his town's field hands, obliged to provide work and pay for any idle hand who wants to trespass and work on his own initiative. Likewise, a patient is not at the mercy of a treatment provider, obliged to pay for any service the provider decides is needed without any need to consult the patient.

The basic rule established by the Talmudic passage is as follows: If the work done is one that the owner routinely carries out and would certainly have paid for himself, then the worker is paid according to the standard rate. Otherwise, the field owner, who is the unwitting employer, gets the benefit of the doubt. If he has a credible claim that he didn't intend to plant this particular field with this particular crop, or a like claim for any other kind of work (for example, didn't plan to build a particular structure), then his obligation is according to an assessment of how much this service is worth to him.

We could apply this principal to your situation as follows:

First, contact the chiropractor and ask politely him to explain exactly what consultation was provided, why it was needed, and why you weren't informed you would be charged for it.

Chances are good that this discussion will itself resolve the problem. The chiropractor may be convinced that you were not adequately informed of the treatment he was providing, and agree to remove or reduce the fee; he may even realize that there is an ordinary billing error. Or you may be convinced that enough information was provided that you should reasonably have inferred that you were obtaining an additional, billable service.

If the difference of opinion persists after your discussion, you should offer to pay whatever you would have agreed to pay for such a "consultation" if you had understood that one was needed and was being provided. The service provider may agree to your compromise, or offer another; if he insists on his position, it is his right to try to enforce it by referring the issue to arbitration, mediation or even legal action.

I recognize that misunderstandings of this kind are common; probably the chiropractor meant to mention that the consultation was a separate service or assumed that you recognized that it was. But precisely because this phenomenon is common, I believe that service providers should be pro-active in preventing it. I advocate explicit "truth in billing" policies stating that customers will not be charged for any service unless they have been notified in advance what service is being provided and how much it will cost (or alternatively exactly why a precise estimate is impractical).

SOURCES: (1) Babylonian Talmud Bava Metzia 101a



The Jewish Ethicist presents some general principles of Jewish law. For specific questions and direct application, please consult a qualified Rabbi.


June 16, 2007

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Visitor Comments: 1

(1) Susan, June 20, 2007 12:38 PM

good answer!

I work as an assistant to a chiropractor. I do have a question for you to ask yourself. Do you come into the office with different complaints/issues all the time and expect him to treat it along with all the rest? Did your diagnosis change? We go through this many times a day. A patient begins treatment for low back pain. A week or so goes by and all of a sudden, they fell and hurt their elbow, wrist and neck. Now the elbow, wrist and neck may hurt and the low back issue is not resolved yet. The doctor has to re-exam all over again. He/She should have let you know about the consultation. It could be known as an existing patient exam. Did you take up more than 10 minutes of his time with questions about a problem? Of course, codes get circled by mistake too. Call him. That is the best way to resolve the issue. I agree with Rabbi Dr. Asher Meir. Thank you. Susan

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