Anyone else injured during clinicals?

LydiaNN · Feb 20, 2007

The way our HMO works, upon enrollment you have to declare what hospital you will use for all situations except those that the HMO considers an emergency. We have PacifiCare, and we've declared the hospital that is just a mile or so from our house is the one we will use. It doesn't matter whether PacifiCare covers our County hospital (it probably does), because that's not part of my particular plan.

Good luck disputing your bill- it sounds like the paperwork is generated upon triage without regard to whether you actually followed through with treatment.

fleur-de-lis, BSN, RN · Feb 20, 2007

Mine's a PPO so we can technically go anywhere, but insurance picks up most of the cost for only the in-network providers, and this hospital was not in-network.

Interesting update, I sent an email to the billing dept at 8Am this morning and now only 3 hours later they have responded stating they are adjusting the balance so that I owe nothing. The email I sent was very carefully worded and not angry in tone, but calmly explained the situation and that I did not feel I owed anything. I added that had I been working as a paid employee I would be entitled to worker's comp, but as I student I have no such right. I explained that I would like them to waive the fee, but understand that if they do not I would not be making a payment before talking to an attorney. My school has free legal advice, so I was prepared to see what my options were. Thankfully, that is not necessary. I hate how sue-happy our society has become, but there was no way I was paying that bill!

LydiaNN · Feb 20, 2007

Yes, our's is a PPO, too, but because I want the highest level of coverage, I only utilize the HMO doctors and plans. That's great the bill was worked out so quickly. I think around here it would have taken months and months.

NeosynephRN · Feb 20, 2007

Hmmm...at my school if you are hurt while in Clinicals you are covered by the schools insurance...as long as you go where they tell you too and do exactly as they say...so if they say to go to such and such ER..then to a clinic and you do they will pay...if you do not and choose to go to your own then they will not pay one dime!!! Of course this policy is different with every school. Good Luck!!

Daytonite, BSN, RN · Feb 20, 2007

first of all, let me fill you in on a few facts about the injuries in the working world. whenever you are injured, any kind of injury, you should be seen by a doctor. your instructor who "forced" you to go to the er to get checked out was looking out for your rights under federal protection laws and absolutely did the right thing. it has nothing to do with your private insurance coverage. whenever you are injured in the course of work, the facility is responsible (unless you did something incredibly stupid to contribute to your own injury) and you are covered under their workman's comp insurance. that is mandated by federal law and guaranteed to every u.s. citizen. as a student, the school has agreements and/or contracts with the facility covering injury to any student that occur in the facility at the time they are engaged in clinical actions. your being seen in the er, whatever they did for you, should be covered under either the facility's workman's compensation insurance policy or your school's Liability Insurance. someone should have also had you fill out some sort of an incident report as well to document your injury. if not, go back to your clinical instructor and ask about this.

secondly, being seen generated paperwork that proves you suffered some sort of injury and followed the rules set forth by the insurance carriers regarding on-the-job injury. this is important because if, down the road, you have problems because of this injury all medical care relating to it is covered by the insurance company of the facility or the school. when an employee goes back later to attempt to get a bill for medical services paid for by the facility in which they were injured and it is denied it is often because they did not follow the facility rules on being seen by the workers comp doctor. many insurance companies will not pay a person's medical insurance bill when they see that the reason for the patient encounter was due to injury on the job. so, your private insurance company may still deny you payment of the services they gave you once they realize what the encounter was for. you might get a bill from them as well. this is because the workmans' comp laws are so clearly defined in the state laws and the insurance companies are going to fight over who ultimately has to pay out the money.

you were wrong to fight going to the er of the facility where you were injured. even if you get a bill for the services of the er, you merely call their billing department (there will be a number to call on the bill) and point out that you were injured while there as a clinical student of xyz college. the billers will work with you on how to get the bill written off.

as a nursing supervisor we had nurses as well as visitors sometimes injured on the premises. number one action was to send them to the er to be seen and checked out by the er nurses and doctors. the facility is liable for anyone who is injured on their premises. especially, if it is in the course of performing work for the facility. all you did was make an even bigger problem for yourself.

as a nurse who has a long term back problem i sincerely hope that your back problem is resolved. i can tell you that every time i saw one of the doctors for my back problem i got letters from the insurance company wanting information about whether or not my back problem was related to an accident or injury. getting pre-approval for my laminectomy was a nightmare. you know why? they were looking to find out if there was another insurance company that should be paying my medical bills on these claims instead of them (car insurance, workmans' comp).

fleur-de-lis, BSN, RN · Feb 20, 2007

In response,

I never said that I did not think I needed to be seen by a doctor. I knew that I needed an ER STAT. I simply wanted to make sure I could pay for the treatment I was receiving by making sure that this hospital was on my insurance plan, and if it was not, I wanted to go to a facility that is on my insurance. I do not see the problem with that. My instructor agreed, which is why we called my husband but he was with a client and did not pick up the phone since he did not recognize the number, so I had to wait to find out. I was not asked to fill out any incident report and the program director is aware of the injury. I do not intend on involving the school any further now that the matter is settled.

Secondly, we spoke to my insurance company at length when this problem happened. This is something that could have happened anywhere (it was not a lifting or slip-and-fall injury), and my insurance company was fine with me going to the other in-network ER. I have paid my co-pay and they have paid their part. Case closed.

I did not "fight" going to the ER. I was protecting myself by making sure I could pay for the charges. My instructor agreed. If there were different procedures because this was an injury on clinical site, she should have told me so. This is not something that I was going to file under the school's insurance unless I had to, I have my own insurance and don't want the school to have anything to do with my personal healthcare decisions, as I don't want this potentially used against me as a student. We were also made to sign a waiver of liability for the school and the clincial site, so I was not about to count on anyone but me footing the bill. And even if the facility is technically liable because I was injured on their property, I am not the type to pursue that legally, I just did not want to be billed since I was given misinformation and did not receive care. And I really don't see how "all I did was make a bigger problem for myself" because the billing waived the charges within hours of my inquiry. The matter is resolved to my satisfaction. My back is fine and we are all moving on.

My purpose in starting the thread was to inquire if anyone else had gone through this, hence me placing it in the student section. I did not intend for it to become a lecture session on what I should/could have done differently. Thank you for your concern.

Daytonite, BSN, RN · Feb 21, 2007

I'm sorry you didn't like the response I gave. My responses are based on a good many years of experience as both a staff nurse and as a manager. My point was that you should not have had to pay anything, not one red cent at all, for any of the care you received. As you pointed out, the billing department of the hospital did adjust your ER bill so that you owed nothing--they wrote off the bill. This is because you were injured on the premises, not because the e-mail that you sent was very carefully worded, calmly explained the situation and that you felt you did not owe anything.