Our local Hospital cancelled my son's surgery appointment and is refusing to provide service?

Question

My son has severly flat feet. After doing much research, we found a locale hospital and physician that would do an outpatient procedure (http://www.medicalnewstoday.com/medicalnews.php?newsid=29846) to correct his flat feet. Since he is required to be non-weight bearing on the foot for a few weeks, they are done one at a time. In December he was able to get the left foot done and we set up an appointment do get the right one done. A day before his scheduled surgery, the doctor called and said the hospital will not allow him to do the surgery because the hospital is not being reimbursed enough for the procedure. After calling the hospital, they said my insurance did pay for the procedure, the CPT code they bill does not reimburse them what the procedure costs. My son has one foot corrected and one foot not. There is no other hospital in town that will do the procedure. I am wanting to take legal action to get this done for him. Does anyone have any advice on this issue? Thanks

Answer 1

I work for free all the time its called being a volunteer. some people are so selfish, and this goes for the first answer you got

Answer 2

The original surgery was not life-threatening. Therefore, the hospital staff shoudl have taken your insurance inforamtion, preapred a quote for the insurers, and sent it off for review before scheduling the surgery or accepting 'proof of insurance'. Also, you (as the insured) should have requested that they do this, so that you would know how much (if any) the insurance was willing to cover ... and how much would be left over for you to pay out-of-pocket.

It's pretty typical that the insurance companies pay to a 'set rate' that is a national average ... if the local guys are charging more, then the difference has to come out of your pocket (if you choose to use the locals for the surgery).

So - the blame for not realizing the procedure would not be 100% covered by the insurance is yours. The hospital is within their rights to refuse the second step, since the work is not to repair a 'life-threatening' instance. At least, they can refuse until the first half is paid in full.

This is one of the joys of having a medical system that is set up as individual profit/loss centers, instead of a national medical/medicare (socialized) system. On the good side, you attract the best in the field ... on the bad side, you have to PAY for the best in the field. Up front, usually ... instead of over several years in federal and state taxes.

Note: You MAY be able to arrange something with the hospital regarding an extended-pay plan to cover the added costs of the second surgery, but given what you've said about the discussions so far, I wouldn't be holding my breath for a positive outcome.

Answer 3

I am sure they can do that, but what I would do now is forget a law suit.. You don't say how old your son is, but try the Shriners hospital and the one someone else gave you..

Education and insurance forces the Doctors to be less giving of services.. They need to pay for alot to practice medicine.. So you have to understand their side.. I do agree that they should have checked it out before doing the surgery, but insurance companies are denying payment.. Unfortinately they leave it to the patient to deal with them.. It is, on the bottom line, how our law makers allow insurance companies to refuse to pay a bill that would be considered selective treatment..
Leaving us frusterated and alone to deal with it..

So if you do hire an attorney, it should be the insurance company I would deal with..
Good luck and hope you get resolve from this.. Children deserve to have the best chances in life..

Answer 4

The first step that I would take is to call your insurance company and see what they can do about it.

The next step that I would take to see if this is considered malpractice... it seems to me that when a doctor consents and schedules to correct your sons entire problem and only does one foot, that someone in that hospital should be held liable for it. That's like only performing half of a surgery and then stopping midway through because you found out that the insurance comapany (that the hospital has choosen to accept as coverage), isn't paying you enough.

Answer 5

Have you considered medical treatment and surgical help for this in India? They are called the Fly2india4health Consultants. I read a lot about them in the Newspapers and about their patient stories. I have also read that they arrange financing for international patients, as all surgery is not covered by insurance or by the stinking NHS.

They also have photos pasted of their International patients. You can checkout their website. The cost savings are incredible. As a doctor I personally believe that your Hernia surgery can be easily handled in India, as the quality of Healthcare available here is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star.

My cousin got her surgery done there and she is more than very happy with the results. She is all praise for Fly2india4health Consultants. As a doctor I personally believe that your medical treatment and surgery can be easily handled in India, as the quality of healthcare available In India is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star. She paid just 20% of the cost what she was quoted in USA and it was like a wonderful vacation for her. Hope this helps

Source(s):
http://www.fly2india4health.com

Answer 6

I would complain to your insurance company. They seem to be the problem on this one. In fact insurance companies seem to be at the root of most of the problems with medical care. The hospital has a right to not lose money. they are a profit center. See if you can find a state owned hospital who will take the hit for you.

Answer 7

If you haven't paid for the last procedure yet why do you think anyone would do another one? Does your grocery store give you groceries without paying? A hospital is a business, not a charity and has to have income or close down. My advice is pay for the previous procedure and then schedule the second one.

Answer 8

Legally speaking, hospitals are only REQUIRED to provide life saving treatment enough to stabilize someone. Basically...so they don't die.

The long and the short of it is that they do not legally have to provide your son with the surgery, just because they did the first foot. Good luck in your plight.

Answer 9

I think the legal term is "dropping a patient", which is illegal. You might want to ask a lawyer. Meantime, call Texas Children's Hospital in Houston, Texas. I know they will help you, they are great.

Answer 10

The hospital is a business just like any other, don't expect them to perform the procedure if they aren't getting paid. Would you work for free?