QUESTION
Do I have to pay medical bills incurred because of an injury caused by a doctor?
Asked on Jun 22nd, 2011 on Personal Injury - California
More details to this question:
I went in for a routine colonoscopy due to being a high risk. Polyps were removed. That evening I ended up in the emergency room. The doctor had burnt my intestines during the removal. That doctor and the hospital are now billing me for that stay. Do I have to pay those charges? Also I started receiving bills for the colonoscopy a month later, only to find out the doctor submitted the wrong code to the hospital. He billed it as medical instead of screening. Supposedly this was fixed after several calls to his office, however 6 months later I am still battling with the insurance co. because they refuse to pay for all of it saying it was submitted as medical. I have submitted an appeal with the insurance co. What recourse do I have if they refuse to pay for the colonoscopy part of it?
13 ANSWERS
Bad Faith Attorney serving Orlando, FL
at
Riley Allen Law
Update Your Profile
Yes, unless you get someone like a lawyer to help you. Or call the risk management department of the hospital and explain what happened.
Answered on Jul 25th, 2013 at 10:17 PM
Business Counseling & General Corporate Attorney serving Seattle, WA
Partner at
Carney Badley Spellman, P.S.
2 Awards
If you have a claim for medical malpractice, you may be able to negotiate and have the bills waived, but that is not an automatic process.
Answered on Jul 11th, 2013 at 10:07 PM
General Civil Trial Practice Attorney serving Beaverton, OR
at
Vincent J. Bernabei, LLC
Update Your Profile
You may have a medical malpractice claim against the doctor.
Answered on Jul 11th, 2013 at 1:21 AM
Automobile Accidents Attorney serving Portland, OR
at
The Law Office of Josh Lamborn, P.C.
Update Your Profile
You can refuse to pay, but unless you use their procedure for challenging a bill, they will likely submit your bill to a collection agency and ruin your credit rating.
Answered on Jul 11th, 2013 at 1:20 AM
Wrongful Death Attorney serving Salem, OR
at
Swanson Lathen Prestwich, PC
Update Your Profile
You should speak to the doctor that performed the surgery and work through a plan to get the right amounts billed and paid. Medical malpractice claims can be, and frequently are, complicated. This probably is not the type of case suitable for a malpractice claim. Your doctor's billing office should be willing to sit down with you and figure out what needs to be fixed and how to do it.
Answered on Jun 28th, 2011 at 11:59 AM
Personal Injury Attorney serving Houston, TX
at
Riley Law Firm
Update Your Profile
The fact that the condition occurred during a colonoscopy does not relieve you of the obligation to pay the bill for the repair. You may have a claim against the physician but perforation of the colon is one of the known potential risks of the procedure which can occur even if the physician does everything correctly. Accordingly, they are exceedingly difficult cases to pursue. On the medical insurance, if your health insurance was provided by your employer (most cases), your options are limited by application of the Employee Retirement Income Security Act (ERISA). You would have to follow the administrative provisions of an ERISA appeal. If it is privately purchased health insurance, you would have more options under the laws of most states. You should consult an attorney in your state with specific expertise in this field.
Answered on Jun 28th, 2011 at 9:32 AM
Brain Injury Attorney serving Baton Rouge, LA
at
The Lucky Law Firm, PLC
Update Your Profile
Thanks for your inquiry. This information is being provided to you based on Louisiana law. Yes, the medical bills still remain outstanding. However, you may make a claim for the medical bills to be paid; however, you will have to bring a claim under the Medical Malpractice Act. Unfortunately, dealing with the insurance company is another story. I would also have the doctor's billing office discuss the charges and the coding with the insurance company. This is a process that is tangled with red tape and usually just requires that you follow the process - although, it is incredibly frustrating. Please contact my office to discuss further. I am happy to discuss all of the issues with you in more depth.
Answered on Jun 27th, 2011 at 6:11 PM
Personal Injury Attorney serving Charlotte, NC
at
Paul Whitfield and Associates P.A.
Update Your Profile
Sorry. question is not clear to me. If you think the Dr made an error you must show that by the testimony of another doctor. The problem with billing codes is unclear.
Answered on Jun 27th, 2011 at 5:43 PM
Theodore W. Robinson
About your only recourse is to sue the doctor, but I expect most attorneys would reject such a case due to the minimal nature of it. Instead, you cancall the doctor and explain what has transpired and ask him/her to be reasonable under the circumstances and settle the bill with you for less money since his office played a role in the entire mess. As for the ER costs, that may increase the value of your claim against thedoctor, but usually all medical procedures carry some sort of risk with them and this may be the result of those risks. Good luck. T
Answered on Jun 27th, 2011 at 4:32 PM
Criminal Defense Attorney serving Anderson, SC
at
The David F. Stoddard Law Firm
Update Your Profile
Normally, you are responsible for any bills that your insurance doesn't pay. If some of the bills were incurred because of the doctor's negligence, in theory the doctor should pay those bills. A bad outcome (in this case the burned intestines) is not always the result of negligence. Some procedures have inherent risks of damage that can occur without negligence. As a practical matter, if the hospital or doctor do not offer to pay or forgive the bill, the costs of pursuing a malpractice claim (not the attorney's fee, but the costs of depositions, expert witness fees, etc.) might exceed your medical bills. Your health insurance should pay all of this except deductibles and co-pays.
Answered on Jun 27th, 2011 at 4:05 PM
You need to retain and/or consult with a medical malpractice attorney. The medical bill will remain your obligation until you resolve it.
Answered on Jun 27th, 2011 at 3:59 PM
Criminal Defense Attorney serving Montrose, NY
at
Law Office of Jared Altman
Update Your Profile
I am not an expert in health insurance claims. But, it seems to me that if the doctor made an error in the way he/she billed something, then the doctor should eat the loss if insurance doesn't pay. I think that's a great argument, but I don't think that it will hold up in court. Certain injuries and/or side effects are known risks of various procedures. If you suffered a known risk, then you have no recourse. If, on the other hand, the doctor committed medical malpractice on you (which only another doctor of his/her specialty could tell you), then "no", you don't have to pay. Please note the following necessary legal disclaimer: I have not given legal advice. I only give advice to my clients. I am not acting as your attorney. I have not yet agreed to represent you. Anything I have said is based on limited information and may be subject to change as more facts become known. Attorneys express opinions. Attorneys often disagree. If you want further information or independent verification of anything I have said then you should immediately consult another attorney. Never sit on your rights! I am admitted to practice law in New York State only and cannot practice law in any other State.
Answered on Jun 27th, 2011 at 3:25 PM
Employment Law Attorney serving Beverly Hills, CA
at
Dordick Law Corporation
Update Your Profile
The question would be whether you are making a claim for malpractice. In situations like this I have had the bills waived as part of a settlement. The problem you may face is that it often takes a long time to resolve these claims and the billing departments eventually turn these claims over to collections and it could affect your credit. It is therefore important when you negotiate a settlement to ensure that they remove any derogatory remarks from the credit bureaus regarding your unpaid medical bills and report the claim as paid in full as opposed to settled in full. Better yet, demand a complete deletion of any derogatory remark.
Answered on Jun 27th, 2011 at 2:33 PM