Now I'm getting urined!!

[Nela]

Can we say pissed on this forum because that's what I really am? On June 30 I went in for surgery to have 2 hernia's repaired at an "out patient" Surgery Center. Things were a little more complicated with the proceedure than expected and I had to stay over night and most of the next day before being released. I was released to go home at 3:00pm but had to go to another hospitals emergency room, as directed by my doctor, later that night. Several tests were run including blood work, x-rays and a CT scan. It was discovered that my stomach and lower bowel had never "woke up" from the hernia surgery plus I had a gas pocket in my stomach causing me to have difficulity breathing. So I had to have my stomach pumped and was finally admitted to a room the next day. That's when things went bad. As I was laying in the hospital bed that evening I told my wife that I was hot and not felling well. I asked her to pull the cover off my feet and legs so I could cool off. As she did this she felt of my feet and my left foot was cold as ice and numb. There was a nurse in the room, and having heard to our conversation, she started trying to find a pulse in my foot. Not finding one she got her supervisor in the room and she couldn't find one either. Things started happening real fast and the next thing I know there's a cardio surgeon standing there telling me that I have a massive blood clot in my left foot and I'm going to surgery. Anyway, the blood clot was removed and a Green Filter was placed in my heart. A few days later I was released from the hospital and NOBODY discussed their billing practice with me or my wife. 2 days later it's back to the emergency room with pain in my right leg. More blood work, another x-ray and another CT scan. I now have a small blood clot behind my right knee and I'm being told that " we are gonna just watch it see what happens.

Now why am I pissed? As I was released from the emergency room here comes a lady from the Administration office and she tells me that some of their patient services, such as, x-rays, blood work, labs, pathology, scans and emergency room doctors may or may not be within our insurance network. If not, we will be billed seperately from the hospital and be responsible for those charges. This hospital IS within our insurance network so one would think ALL srevices that they provide would be covered, as well.

Now I have talked to our insurance provider and was told that I can "appeal" these charges and "more than likely" the insurance company will pay the additional charges. BUT they will decide what the services are worth and only pay that amount. If that amount does not cover the charges WE will be responsible for the difference. These costs will be above and beyond any deductables or out of pocket costs we we have to pay. Not sure if I want to wait and see how this goes or just pack my bags and move to Mexico.


Nela

[Bingoccc]

Ouch. Sorry to hear that. Certainly follow through with the appeal. I've had to do it a couple of times and I always ended up free and clear after. Good Luck!

[RustyZombie]

I had the wrong idea from the thread title, although it sounds like being peed on would have been a more pleasant experience than the one you had.

Stories like this is why it is important to know your policy inside and out. However, that is much easier said than done. I wish you the best of luck in dealing with the hospital and insurance, and a speedy recovery.

[Smitty70]

I hope you get well soon and your ins. problems come out in your favor. Will pray for you.

[jpd]

"emergency room doctors may or may not be within our insurance"





Hoowee...........it can be dicey! Nela, hoping you get thru all this so you can unpack your bags!

[catdaddy]

Here's a link http://www.tampabay.com/news/health/...tients/2198506 to an article that describes how medical insurance can list a particular hospital as an approved/preferred provider of services yet depending on what medical group is operating the ER at that hospital the ER could be considered an out of network provider. Our medical system is fragmented, confusing and littered with these contract "landmines" which make it almost impossible for the average person to navigate successfully. My sympathies. Hope you have a speedy recovery and don't have to deal with any outrageous out-of-pocket expenses. Best of luck.

[Psalad]

The US health care situation gets me SOO PEEVED!!

My sister in law just got diagnosed with cancer. But what apparently happens is she will essentially only have a certain amount of medical leave, then will have to pay her healthcare herself out of pocket. PLUS there is no guarantee she will have her job back.

[mtsusean]

A call to Dewey, Cheatem & Howe would be a wise choice right now

[Glennwillow]

Nela,

I'm sorry for all you have been through medically, and I'm also very sympathetic to what you may be going through with your insurance and your potential expenses. I hope this situation turns out better for you than it appears right now. Best wishes to you...

- Glenn

[chitz]

Sorry for your troubles. I hope that in the end you will be healed in both body and bank book.

If I say more about health care in the U.S. it will put me out of favor with the mods.

[Chicago Sandy]

Sorry to hear about your “cascade of complications.” There seems to be a lot of that going around these days.

If you appeal, citing the fact that one has NO choice of ER doctors in a covered hospital (and that the possibility of the ER group being out-of-network was disclosed to you only *after* services were rendered and you had no opportunity to go elsewhere), your insurer will likely back down. If they cover less than the full amount, and the ER group balance-bills you for the difference, appeal that too (citing the same reason). Meanwhile, I would also have a good malpractice atty. investigate as to whether the failure of your gut to function post-surgery and/or the clot may have been caused by an avoidable complication (or one not disclosed on the consent form you signed). Even if you don’t have to litigate, you may be able to settle for an amount that would cover both the billing shortfall and the atty. fee.

[Brucebubs]

I do understand there are risks with any medical proceedure but after Flaggerphils recent bad experience, I can't help wodering what's going on over there?
Growing up in Australia with a steady diet of US medical dramas on TV -Dr. Kildare, Ben Casey, ER etc, etc - I always thought the US must have the worlds best medical care.

Hope it all goes uphill from here, all the best.

[Chicago Sandy]

"Excrement manifests," to use a euphemism in order to avoid running afoul of the forum software’s censor-filter algorithm. Nobody ever reads the consent form before signing it (not even doctors as patients), but just about every possible complication other than just “oops, my bad” is disclosed in advance. I’m leery about surgery under general anesthesia, since for even an otherwise healthy person there’s about a 2% chance of not waking up. And for certain operations, such as joint replacements and other lower-extremity open surgeries, the risk of infection or blood clot is higher. But it’s a matter of playing the odds--and almost overwhelmingly, the chance of death or permanent disability from not having the surgery is far greater than the chance of equally serious complications resulting on the table or thereafter.

And there is a difference in med-mal-speak between injuries caused by negligence and known complications that may or may not have been avoidable. For instance, take colon perforations during colonoscopy (sound familiar)? If the colon is perforated even if no polyps are attempted to be excised and no diverticula are present to trap the ‘scope, that is almost always malpractice; but if the ‘scope gets stuck in a diverticulum or a large polyp is excised (especially in an area where polyps were previously excised or biopsied) and the laser or cautery snare goes too deep, that is a known but possibly unavoidable complication. That it doesn’t occur more often is a testament to the skill of the vast majority of practitioners. A resident we talked to at Bob’s last trip to the ER put things in perspective: when she tore her ACL and needed to have it surgically repaired, she did her research and picked the top orthopod in town, with the most stellar safety record. She got an infection....which was that surgeon’s first ever in over 20 yrs. of practice.

[harmonics101]

I'm going to express an extreme generalization when it comes to health care, I'd rather get sick, ill or have a procedure, surgery done in the Northern Hemisphere of the United States instead of the South.

H

[seannx]

Health care in the U.S. is a for profit business, and while generally good, complications arise, and often are due to quality control issues and poor judgment. Like the OP's experience, when something goes wrong, you may need more medical care and expensive procedures, and then can find out you may not be covered for the extra services. Services you may not have needed had the procedures been done right to start with, but you are expected to pay regardless.