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question re: informed consent

Nurses   (924 Views | 4 Replies)
by pkmom pkmom Member

pkmom has 2 years experience and specializes in critical care.

3,256 Profile Views; 156 Posts

We had to take my son to the ER a few months ago and the MD ordered 3 CTs and only told us about 2. The bill is outrageous, our insurance company won't pay all the charges because they are beyond what is reasonable and customary. we need to get this fixed soon, this is the closest hospital that is hiring and I graduate in a few weeks. Do we have to pay this bill when we weren't informed about the proceedure and did not give consent?

Any help would be appreciated.

sb

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2 Followers; 14,620 Posts; 106,371 Profile Views

I can't predict the outcome, but it is certainly worth making a formal complaint to the hospital. CMS patient rights rules require the hospital to have a formal process for investigating and resolving grievances. If you don't get anywhere with the hospital, call your state agency that licenses hospitals (often a part of your state Dept. of Health and Human Services, or whatever your state chooses to call it -- but there is definitely a state agency that licenses and regulates hospitals in your state!) and file a complaint with them.

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pkmom has 2 years experience and specializes in critical care.

156 Posts; 3,256 Profile Views

Thanks for your reply. we found a third party file a complaint and negotiate the situation for us.

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hoolahan is a ASN, RN and specializes in Home Health.

1 Article; 1,721 Posts; 23,417 Profile Views

Unfortunately, when you sign the general consent form in the hospital, that may kind of cover this, since, unless you have contrast, you don't need an informed consent for a CT scan, because basically there is no risk to the pt.

If that is a problem, I would call the insurance company. If you used a hospital in the network, they are supposed to accept the reasonable and customary payment as payment in full, and not send you a balance bill UNLESS, you haven't yet met your deductible, and that may be per family member. I would ask for the complaints or quality dept's of the insurance company, if you don't get satisfaction, ask to speak to a supervisor.

When we recently had to switch in sur co's due to hubby's job restructuring, I went through HE!! to get bills paid. Fought for lab bills, doctor bills, and now my son needs surgery, for impacted wisdom teeth, so I am really nervous. To top that off, at my new job, they enrolled me into medical when all I signed up for was dental. How they chose a plan for me I don't know, but HR gave them holy heck, and now July's bills are coming back with second payer issues, which was an error on their part.

Had to fight with aetna over hubby's stress test, they still never paid that, know why? The hospital incorrectly coded it as in inpatient procedure, but he was an outpt, they didn't care. In hind sight, I should have asked for medical records.

In fact, I would advise you to gather the records, there is a $10 fee plus $1-1.50 per page, you have to send a letter in writing, call the hospital to find out their specific procedure, and then you will have evidence to submit to insurance company.

Also, I do recall seeing posted in every ER, that they cannot refuse to treat you if you can't pay, and that you will be notified of all charges up front.

So, prepare yourself for aggravation, cause you will get a LOT of lip service, and little action, unless you are lucky enough to find the few people in these companies that have a good work ethyic and truly want to give you customer service. I know, I work in an insurance company, I am a lot wiser now!

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433 Posts; 6,141 Profile Views

did you give verbal consent to a ct scan? If so i'm afraid you have consented to the scans and in the eyes of the law it stands. Also if you knew they did 3 ct scans why did you not insist they gave you the results of the 3rd scan? sorry as far as insurance goes i havent a clue how it works as we do not have medical insurance here in the uk unless we wish to go private, but i thought that if you have the right cover and you are paying the right amount then they should pay for the scans, no matter how many they do. Does the doctor have to fill in a form to say the scans were done and the reasons why 3 scans were done. if so surely they should pay.

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