Do I have any argument/defense? (lawyer help?)

Discussion in 'The Fire Hydrant' started by Dreeza, Mar 5, 2012.

  1. Dreeza

    Dreeza New Member

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    I had to go to the ER & on top of being treated like absolute crap, I had a CT Scan ordered, which I was against. There is much more to the story than that, but we'll leave it at that. I strongly believe that it was not medically indicated for them to order it, but I was not given much choice at the time.

    I am now left with a $1700 bill (insurance is covering like 6500 or something, so they didn't deny it completely). I don't know how the heck I am supposed to pay that.

    I've written an essay describing my experiences and plan to submit it to the hospital (did that BEFORE my bill). Not sure what else I plan to do, but it is in hope that some of those involved in my care will be reprimanded. I really do not expect hotel service, but my treatment was ridiculous & the doctor who treated me was a complete idiot who was blindly ordering tests with zero reasoning. Which is a fact.

    Anyways, I am ok to pay for the services that I feel were necessary, but am so not ok with the CT scan. The bill they sent me isn't even itemized, so I think that is going to be my first step (umm would be nice to know what I am even paying for!!)

    Beyond that though, does anyone have any advice?

    I've fought a denial before, but this is different since they technically didn't deny it (at least I dont think so since it says 6500 was covered).

    But this is beyond ridiculous...
     
  2. joce

    joce Active Member

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    I'd say no. Drs follow guidelines of treatment.

    You can apply for aide and they do drop the bills a lot even if you have insurance supposedly. Don't quote that though. Just say its a financial hardship.

    And as long as you pay something like 2$ a month it can't be sent to collections.

    I was just complaining my dr does not do enough test and could have diagnosed my issues years ago. Some drs are over the top but usually they follow set guidelines for a certain treatment.

    I did get out of paying some things when I got billed for a left hand X-ray when I wen in for a sore throat. Not something like that right? Care to share?
     
  3. JessLough

    JessLough Love My Mutt

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    ^^that. Generally, there is a set amount they have to do, so they don't miss something and get sued.
     
  4. Dreeza

    Dreeza New Member

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    Joce - whaaat!! why'd they give you an xray?? lol


    Anyways, here is the thing...if they are THAT concerned about everyone with right abdominal quadrant pain having appendicitis, then why even WAIT for an exam? I sat in my ER room for prob an hour or more before I was even seen by a doc & the CT scan was ordered.

    When she made her decision (which was based on a NEGATIVE palpatory exam & not consistent with my signs & symptoms), I questioned her, asking WHY. She had NO answer...and said "okay, we can do an ultrasound instead then if you don't want the CT scan".

    I barely argued...if she is going to back down from her decision THAT easily, then it was NOT medically indicated at the time. What doc would let some 25 year old punk talk them out of their decision just like that???? ESPECIALLY for a life-threatening diagnosis...which appendicitis is.

    I ended up getting the scan hours & hours later (again, negative to the exam & negative signs/symptoms). I had just given up at that point. I questioned her again & she basically gave some BS. At that point, I had been up for over 24 hours & had just been put through the most painful thing I had ever experienced in my entire life. Really did not have much of a fight left in me.
     
  5. Lilavati

    Lilavati Arbitrary and Capricious

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    Welcome to the disaster that is the American medical system.

    Required disclaimer: I live in VA, but I'm not licensed there, and this is not my field.

    My instinct here is you can't do anything in a legal sense, unless your VA has a patient bill of rights that gives you grounds, and I don't think we do. (We do have an informal one that the hospitals have agreed to here (http://www.aha.org/advocacy-issues/communicatingpts/pt-care-partnership.shtml) but it seems to dump the responsibility for being "involved" in your care on you)

    You were conscious and you didn't refuse treatment (which you have a right to do) so you agreed to receive a service in the form of a CT scan. That you didn't need it is irrelevant, as is the fact that they didn't tell you what it would cost. I'm afraid you are a victim of defensive medicine . . . she probably ordered the CT scan to over her own behind.

    The service sucked and you should complain. I know for a fact that the state will cover some percentage of medical expenses in case of hardship (at least for the uninsured) but I don't really know how it works, but I suspect the hospital does. Also, talk to your insurance company and find out what they aren't covering and why.

    But I'm afraid this sort of thing is pretty much how the system works. People are asked to make treatment decisions about while they are sick, exhausted and confused, with inadequate information about the costs and the need for the treatment, by doctors who are afraid they will be sued and will thus order everything, which is all covered (if you have it) by insurance that is often written in impenetrable legalese and serviced by people you can't get a hold of.
     
  6. ACooper

    ACooper Moderator

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    I agree with Lil, nothing legally you can do about it. :(

    Here's a little something:
    Last new years (not 2012, but 2011) my oldest daughter went to a party with her boyfriend. My daughter was 19 at the time, and her boyfriend 21. Of course there was alcohol and my daughter, even though under age, thought it would be a good idea to drink it :rolleyes: She is a size 00, all of about 100lbs, isn't normal for her to drink, so you understand it didn't take much to get her blitzed.

    Once drunk, she panicked and started to hyperventilate, got light headed from hyperventilating, and pretty much pass out. This panicked her boyfriend who immediately drove her to the ER. The ER called us (this is like 11:30 at night before the new year came in) because she is under our insurance and we are emergency contacts. They wouldn't/couldn't tell us anything over the phone except that she was "Unresponsive"

    We live about 1.5 miles from the hospital. By the time we got from here to there they had already performed an ultrasound and had a CT ordered! :confused:

    We rushed in, she was jabbering on about 'stupid nurses'........I thought she sounded a bit 'off'..........I got to her side and bent down to kiss her forehead and could smell the alcohol. :rolleyes: About that time the ER doctor (a lady) walked in and informed us that our girl was being taken for a CT! I said, NO. She doesn't need a CT, she is CLEARLY DRUNK.

    Know what happened next? The doctor said too bad :eek: Yep, our daughter was 19 so we weren't in charge. Since she was 'incapacitated' and unable to make her own decisions, the doctor was now in charge of the decisions so too bad what we thought!! They took her for a CT on top of the Ultra sound............basically RAPED our insurance card right in front of us and there was not a thing we could do!

    Moral? SIGN HIPPA FORMS KIDS! ASSIGN SOMEONE TO BE IN CHARGE OF YOUR HEALTH CARE IF YOU AREN'T ABLE!!

    The only bright spot is WE didn't pay for that little folley.........SHE had to pay off what the insurance didn't pay, still not fair to our insurance though.
     
  7. release the hounds

    release the hounds Active Member

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    I don't think there is much you can do about it. I've heard similiar stories from all over, even been involved in a few. Complain, raise hell and be prepared to hold your ground probably get sent to collections and take a hit on credit, but it goes away :)

    I don't believe this notion of "defensive" medicine. It's more like, increase the profits, medicine. It's a nice excuse, that "we" have to do these tests to cover our butts, but really, it's more like, we have to do these tests if there is decent insurance and if there isn't we get them out as soon as possible with the least amount of testing necessary.

    It happens everywhere. Sure some complaints of RLQ could mean appendicitis, it could also mean a lot of other things. There are skills you acquire, or should acquire becoming a doctor. Besides learning how to listen, look, and feel, you should also learn a fair bit about using your brain a little bit and doing some actual doctoring.

    Most cases of appendicitis can be made clinically withOUT imaging and should be IMO.

    But it's easy to pass the blame these days and blame people like Lawyers :) You see, we HAVE to run all these tests because if we don't, we'll be sued. In actuality Malpractice cases are extremely difficult to prove. Won't stop a few cases from being brought about, but even if you're halfway doing your job as a clinician, you aren't losing a case.

    It's not uncommon for admins to sit in a meeting and go over procedures and symptoms and see where more money could have been made in that case. You do get leaned on as a clinician that isn't going with the flow as well. How much depends on the greed above you and the insurance for the patient sitting in front of you. I've seen cases where it's obvious imaging needs to be done ASAP and they're given pain meds and told to come back if it persists and people who were acurately diagnosed in 5 minutes by simply listening and examining the patient in front, but were then ordered on to have MRI's and anything else to bump up that bill. It's amazing just how broken the system is.
     
  8. joce

    joce Active Member

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    Honestly I work in a hospital and every third person screams I'm gonna sue. This is why every test in the book is done when it comes to things like this. And the er sucks for everyone. We get reimbursed like crap and staffing sucks. Just how it is. I go to a er that is extremely tiny and would never dream going to the one attached to my hospital.

    I never had a left hand x ray! No clue what happened. I think the wrong billing code may have got put in but it was a charge for a second dr looking at me that made me catch it. I went into the er because my gums swelled over my teeth in like an hour. Never seen anything like it and the drs were stumped. Said it must be strep even though the test was negative:cool:

    And the back of the bill(or front) should have a spot that says call this number if this is a hardship for you. Call and ask who you can go in and talk to. When my bf was like 19 he had a dirtbike wreck that resulted in multiple lifeflights and a rod in his leg with no health insurance because his employer decided to say he was dropped as of the friday before:eek: He went through them and they dropped it all I think.
     
  9. Lilavati

    Lilavati Arbitrary and Capricious

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    I don't remember the process, but as I mentioned above, I know VA has a program for this situation. When I was in law school Mike was run off the road while riding a bike by a car, and he hit a tree. Because it was a head injury, they made him take an ambulance 2 miles to UVA. Then they made him sit there for FIVE hours, without seeing a doctor.

    I got home, got his message, rushed to the hospital, and he's still waiting. Finally they see him, and give him aspirin, some antibiotics, and stitches, with me serving as the nurse, because they were understaffed. No tests . . . I guess the fact that he was still conscious and coherent indicated no brain damage.

    The bill? $1500.

    I don't remember exactly how we did it, but the state of VA covered half of that. Which is good, because we sure couldn't.

    I like to joke that if he'd taken a cab to a veterinarian, we would have gotten better, faster service and come out of it for under $500.

    Of course, the speeding careless jerk who ran him into the tree didn't pay a dime. We don't even know who they were.
     
  10. JessLough

    JessLough Love My Mutt

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    CT scans do more than check for appendicitis. Could have been a number of things, which a CT scan would allow them to check for.
     
  11. Jynx

    Jynx New Member

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    I had a recent experience and what I learned.

    Went in for an outpatient biopsy, no one told me I had a 5000 outpatient deductable even tho this was a 'diagnostic procedure'..So I got stuck with a bill of 3000. My husbands company paid 2000 of it, (very nice of them!), I now had a balance of 1000.

    I asked to make payments since my work was cut back for the winter, I said I could afford a minimum of 25 a month..They wanted 50, then 100. I said no, nasty nasty office people:) I contacted a lawyer, and here anyway, I could pay 5.00 a month if I so choose, but the hospital could also turn me over to a collection agency if they so choose.
    which in turn would go on my credit report.

    I finally got really PO'd about the whole thing, and contacted the head supervisor of the billing dept. She told me I 'should' have had an explanation of payment PRIOR to the procedure, as they DO check with your insurance PRIOR to the procedure to see what they do and don't cover. Never had that happen. She agreed to accept a minium of 25 a month for the bill, Funny thing is, I haven't gotten a bill in over 2 months. So I guess I will contact them since I'm not trying to get out of paying it.

    So I learned here anyway, it's BS when the all say they can't do a thing if you only pay 5.00 a month, they CAN turn you over to a collection agency if they choose. And you can certainly pay THEM 5.00 a month, but it goes on your credit report.

    When you sign for ANY procedure, you are signing that whatever your insurance doesn't cover YOU are responsible for it.

    Yes, I do think the medical system sucks here.
     
  12. joce

    joce Active Member

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    As far as I know as long as you are actively paying they CAN NOT turn you over to collections. They may threaten to try to make you sign an agreement because then they can turn you into collections when you do not pay but as long as you pay a couple dollars a month on medical bills you are good-just never enter into a agreement. At least thats how it is here.
     
  13. sillysally

    sillysally Obey the Toad.

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    They could have been checking for gall bladder issues too. When I went in for what turned out to be a gall bladder attack (had no idea that's what it was) they did a CT scan after the initial exam-and I had no appendix so they couldn't have been checking for that. Remember that on the right side of your abdomen you have not only the appendix but the gall bladder and an ovary, and it doesn't seem to be uncommon for things to go wrong with any of those three parts. Heck, when I went in for emergency appendix surgery the doctor told my mom they still were not sure if the problem was my appendix or my ovary and wouldn't know until they went in.

    Not saying they didn't screw you over, just saying that they could have been checking for more than appendicitis. As far as the bill, I have dealt with two different hospitals in regards to large bills, and they have worked out a payment plan both times.
     
  14. Dreeza

    Dreeza New Member

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    Wow...def lots of crazy stories. Thanks for sharing everyone. So friggin ridic how this stuff works. The thing about the ct scan...while it def does check for other things, none are life threatening..nor did I have signs or symptoms suggesting something that needed to be diagnosed in the moment. If anything, by that point, my pain had somewhat improved..not worsened. I understand defensive medicine, but at the same time, that should not mean ignorant medicine, like rth was saying. The part that makes me so mad is that she could not verbalize her reasoning to me. Every. Single. Day. I am grilled by a patient or two demanding to know exactly what & why I am doing something. I always have a reason & am always honest about it.
     
  15. Dekka

    Dekka Just try me..

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    wow I can't imagine needing to worry about what they are checking. Or the idea that they might check more to try to get more money.
     
  16. Greenmagick

    Greenmagick New Member

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    oh but according to a nice portion of the US, in Canada you cant get anything done, they never get you in;)

    OT but it always cracks me up when I hear - but in Canada you have to wait months for an appt. Yeah, same here, if you are lucky enough to have insurance!
     
  17. Dekka

    Dekka Just try me..

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    But in reality it doesn't happpen that way often. Sure it happens on occasion, but far less than the media makes it out to be. I have to say I have gone in to the emerg and been seen right away.

    Look at Nilly.. no waiting for her. A friend of mine was diagnosed with MS rapidly. Over all I would take a cheaper (for the tax payer) one where I didn't have to worry about unneeded proccedures that was available to all.

    Just saying the idea that I could go in and have to worry about 'extras' had never occured to me. On the other hand when my Uncle was in the US and got sick they fought to get a test run, the insurance said no. He came home and they ran it right away. (same test was cheaper by a factor of 10 here too) Just saying I would rather they just do what is needed and not have to worry about making money or what the insurance will pay for. Things I had never thought of till this thread.
     
  18. Greenmagick

    Greenmagick New Member

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    Oh I know the reality isnt that at all lol...it was supposed to be tongue in cheek.
     

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