by FLTraumaRN » Wed Sep 12, 2007 04:23 am
I work for a hospital that has a employee funded/self insured hospital. I ended up needing surgery. I jumped through all their hoops and they authurised the surgery. Now they won't pay and sent me to collections with all the doctors and the hospital after the surgery. I have done the appeals process, contacted the Insurance commisshiner of the state of Florida, I have contacted the US labor board, and even the IRS because I was Told to. I don't know what else to do. Can anyone help? I just contacted an attny about this, But am afarid that if it gets heated that I will lose my job. I forgot to mention that I was politely reminded that if i didn't back off I could lose my job.
Posted: Wed Sep 12, 2007 07:11 am Post Subject: Get going!
Hi my friend, lemme just tell you that you have already gone too far to reach out to your expectations. But I believe that your policy papers would clarify the clauses that support such a surgery in connection with any self-funded or employee-funded hospital. So, it is important for you to go through the policy papers or get them explained with an attorney soon after you have got your adjuster's views on it. I would also like to say that there is no need to hire anyone to fight for you...you can always hire men for just guiding you upfront!
I guess thats a much better idea once you have trudged so far with anything, Seaman
Posted: Wed Sep 12, 2007 08:41 am Post Subject:
My friend I hardly can see a road ahead in which I can direct you to go. Normally, employee funded plans are often less flexible in terms benefits than the private health plans. Make sure (I hope you have done it already) that the surgery you have undergone was covered under your policy. If it is not you can't file a claim for it. It also shouldn't be beyond the coverage level. In that case, they will only pay up to the coverage level and the rest you need to pay out-of-pocket. Fiona
Posted: Wed Sep 12, 2007 09:41 am Post Subject: Insurance won't pay
Whole Story,
Auto accident, taken to the hospital that I work for by EMS, seen in ED and treated and released. 1 month later still having symptoms. Went to PCP MRI done. Authurized MRI with insurance and they paid for it. MRI showed Emergent Need for Cervical Decompression (NO SPINAL CORD SIGNAL @ C-4/C-5)with laminectomy, discetomy, Cervical fusion @C-4,C-5 and C-6 with titainum fixator plate. Was not allowed to go home placed in a Leather Fixation collar, Flown to sister hospital to have Surgery. After MRI insurance notified and everything was given authurization #'s from helicopter, to admission to sister Hospital, and the Surgery. After Surgery spent 1 day in Hospital then went Home. 30 days of recovery and back to work. My auto ins was used as primary and they were used as secondary. Well they Only paid for MRI and nothing else. I went Through appeals, no results, tried INS commish with no results, US Labor board No Results, IRS no results. I have been threatened that I might just lose my job If I don't let things lie. I only have two more Avenues Using an Attny and then going to Local News Station and Blow this whole thing out of the water. ANY HELP HERE?????
Posted: Wed Sep 12, 2007 11:18 am Post Subject:
Oh my goodness what a mess ! I'm so sorry !
I guess it depends on what it is worth to you, if you feel you are right and want to fight this, then I think it's time to consult an attorney. They will be able to tell you quickly if you have a case, be sure and take all your documentation with you to your first consultation. Many attorneys do not charge for the initial (assuming it will be a contingent fee) consult.
Also if you can get a tape or some type of documentation re: this superior advising you to 'let it lie or risk lossing your job' I'd do that as well.
I think before going to the media I definately would contact an attorney.
Again so sorry and wish I could offer more assistance, don't suppose they docs and hospital would 'write off ' the balance due to financial hardship, or economic reasons, I know many do.
Good luck, and again I say see an attorney for advise NOW!
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