Urgent advice needed

Discussion in 'Chit Chat' started by Didoe, Jul 29, 2008.

  1. Didoe

    Didoe New Member

    I'm in a desperate situation. I really dont know how one person can get into as much trouble as I do.

    When I had surgery 6 months ago, my personal things were stolen by security. When a nurse went to retrieve my things so I could leave, security denied receiving anything. Long story made short, I was very upset, so upset that the nurse came in and said quietly for me to please shut up for my own safety. I left without being discharged. And here's the problem: After approving the hosptial stay, paying some bills, send me other bills which I paid, the insurance company is refusing to pay an enormous bill for 6 days stay because there was no "authorized discharge."

    My HR told me I can appeal but it will 99% not be granted. The insurance co. sent info on what has to be done; basically doc has to now 'discharge' me, and hosptial has to change all the codes and resubmit the bill. My HR threw it back at me,"this is what the insurance co. sent, call me if you have any further questions"

    Is there anyone here with legal expertise? There is no way I can pay this bill and will not consider making a payment plan, its too big for that. I do know that if you start to pay you cannot renege, you must complete the agreed terms of payment.
    I have to go the the hosptial billing office and plead for mercy but not sure I should do anything without a lawyer.

    You know this situation is so bizaare, so over the top on a mountain of problems I can't even get upset, its just so unmanageable. If I'm sued...my credit has been shot for years anyway. I just dont know what to do...fed up and tired
  2. therealmadscientist

    therealmadscientist New Member

    Didoe, if you had died, would that be considered an "unauthorized discharge"?

    On brighter side(?!#@+*%##), mostly likely the hospital billing office would be on your side......unless they are willing to take on the insurance company then the chances of getting paid are nil.

    Sorry I can't help with the legal stuff. With right lawyer maybe you could sue insurance company, hospital, for "bad faith" or on some general common law principal.

    Such a waste though. So many people employed making other humans feel rotten? Somehow, I really don't think America can afford to have most expensive medical system in world and just get mediocre or whimsical medical care.

    Probably a million people would be thrown out of "work" with real healthcare, reform, but society would probably be healthier. Sigh. Your Mr Bill
  3. Didoe

    Didoe New Member

    I can't beleive they would try and get out of paying for the bill for this reason. Presumable everything was covered if you did have authorized discharge, don't understand how they can try and get out of paying the bill for this reason.

    That being said,
    hi lincamp

    I want to answer your questions, if only for myself:)
    I was due to leave same days, within an hour or two, that's why a nurse kindly went to get my things, I was so stitched it was hard to walk.

    I dont know if doc had already written discharge papers, but you never seem to get those until the nurses feel like giving them out.

    I did not leave AMA at all, I was due to leave, doc said I was to be discharged and then security said, we never got anything from her and sent the nurse back. I'm pretty sure I kept the slip they gave the nurse.

    No complaint was filed; once security was called and told I left, they suddenly found my things and were calling my job trying to find me and return what they took.

    Since I dont live in NYC, my colleague had to take time from work and go retrieve the stuff; but not before calling our college legal counsel asking if it was okay to get involved. A freakin mess all around because some low life had to steal a cell and $20.

    Thanks for the phone #, I'll probably use it.
  4. dragon06

    dragon06 New Member

    It sounds like you just need to talk to hospital billing and have them get it coded right.

    I had trouble after my surgery that my hospital kept putting the wrong codes on things so the insurance kept refusing to pay. We kept after the hospital and eventually they got it coded right and the insurance covered it.

    Go in and tell them what your insurance company says you need...the doc discharge, the papers coded correctly and so on...
  5. zenouchy

    zenouchy Member

    The tush is for the people being so rude and jerky to you. I am so sorry this is happening to you. It makes me really mad. The authorized discharge claim is nonsense. Insurance companies love to make up excuses not to pay. It saves them lots of money. I've seen shows on Dateline about it. If people won't fight the claims, they save big time.

    Does HR stand for hospital representative? If so, he/she is being completely lazy and not doing the job they are being paid to do. I've had hospitals and doctors office change codes all the time, but it wasn't for charges nearly as big as this. They make errors constantly.

    If this person will not help you, DEMAND to speak to a supervisor. DO NOT TAKE NO for an answer. My caps are not me yelling at you, rather it's me telling you to be strong and emphatic about it.

    I don't blame you for feeling so upset and feeling beaten down. If you don't feel up for this (I totally understand if you didn't---I don't think I would), have a friend or relative do this for you. When I was going through the process of fighting the insurance companies and not getting the results I needed or I was not feeling well (I know this takes energy, BELIEVE ME!), my husband would call up doctors offices and pretend he was a lawyer and demand immediate help and resolution. He would also make up the name of a legal firm to sound legit. It's worked every time. These people are scumbags and are trying to rip you off. Normally my husband would not do this, but plain and simple, these people are con artists trying to rip you off, and in this case, it's for thousands of dollars. He would tell them that he was going to charge them for his time. When he played hardball, they really responded.

    Doctors offices and insurances people love to play cat and mouse and blame each other for the other one's errors. Have a friend demand to speak to supervisors on each end and ask them both to solve the problem until one of them (or both of them) own up to it and fix the problem(s). Get them to do a conference call if necessary so that they can't play the cat and mouse game.

    If a supervisor will not help, ask to speak to THEIR supervisor. Heck, talk to a director or vice president if that's what it takes. Don't let them intimidate you. **The hospital can change the codes and so can insurance companies.** It's pretty simple. We've gotten them to do it several times. It's not rocket science as they are claiming it is. *Be sure to have them send you copies of the corrected records.*

    I would expect that you would get results from the steps outlined above. However, if you don't, I would consider tell them as Lincamp suggested, that if they do not resolve the situation, you will be calling the Attorney General's office and/or the Health Care Bureau's Hotline. Give them one last chance to respond. If they STILL don't, I would definitely call these two places.

    We've caught them lying---several times, and office managers at doctor's offices tell me that these people lie CONSTANTLY!! The HR person could easily be lying to you about the 99% appeal denial. They are often lazy and don't want to work. He/she has no interest or stake in your outcome. What does she care? The less work for them, the happier they are. They are even TAUGHT to lie and be con artists because again, it saves them money. Pretty sick and twisted, isn't it? Don't let them. Follow the tactics I laid out for you, and have an assertive and objective friend or relative help you out.

    I REALLY hope this helps. Don't give up!! I'm pulling for you! I'm out of town next week, but I will be thinking about you and looking forward to an update. My thoughts and prayers are with you for a successful outcome.

    P.S. Give Mr. Boo and Boo Too and kiss for me. :)

    Warm hugs,

    [This Message was Edited on 08/06/2008]
  6. Didoe

    Didoe New Member

    I'm not sure you guys understand what I wrote, or, I dont understand this is not the catastrophe my employer is making of it and isolating me with absolutely no help--I have no lied to employer or insurance company. I told them bluntly I felt threatened when security lied and said I didnt give them property, insisted my "family" picked up (what they previously said I didnt give them) and after repeatedly refusing to return my stinkin Nokia, discovered it upon finding I left on my own from the hosptial.

    I really do think, they haven't said so, that employer and doctor are afraid to get involved with this. They dont care if I'm stuck with a $55K bill that I can never pay. I haven't gone to Billing yet, but I will. I sent the insurance co. a letter informing them I am appealing their decision and why and told them they know how critically ill I was because they paid 4 prior ER admittances that year, so they're full of it.

    So you all have been very helpful but I wasn't sure you understood that no one on my end is helping or asking if I need help of any kind, they've just sort of quietly crept away...the one man who's had my back at work, when he heard what insurance pulled said, 'we'll get thru this together, dont worry...' and that was 2 weeks ago. Haven't heard a word since. I may vent here, I dont ask anyone for help in person...I made that mistake while lying half dead after surgery and I swore never to ask strangers for anything even if it meant dying in a gutter, learned my lesson. YOu know I have so little in material things, never owned a home, if the hosptial is stupid enough to argue and not help me get this bill paid, not much they can do, there's nothing to take. Sue me? good luck.

    Its not that I'm tired, the office is a mad house. they decided starting this year, no carrying over vacation days. use it or lose it, so everyone is disappearing suddenly...italy seems to be popular this year:)