Do I have to pay medical bills incurred because of an injury caused by a doctor? 21 Answers as of July 25, 2013

I went in for a routine colonoscopy due to being a high risk. Polyps were removed. That evening I ended up in the emergency room. The doctor had burnt my intestines during the removal. That doctor and the hospital are now billing me for that stay. Do I have to pay those charges? Also I started receiving bills for the colonoscopy a month later, only to find out the doctor submitted the wrong code to the hospital. He billed it as medical instead of screening. Supposedly this was fixed after several calls to his office, however 6 months later I am still battling with the insurance co. because they refuse to pay for all of it saying it was submitted as medical. I have submitted an appeal with the insurance co. What recourse do I have if they refuse to pay for the colonoscopy part of it?

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Law Office of Travis Prestwich, PC
Law Office of Travis Prestwich, PC | Travis Prestwich
You should speak to the doctor that performed the surgery and work through a plan to get the right amounts billed and paid. Medical malpractice claims can be, and frequently are, complicated. This probably is not the type of case suitable for a malpractice claim. Your doctor's billing office should be willing to sit down with you and figure out what needs to be fixed and how to do it.
Answer Applies to: Oregon
Replied: 6/28/2011
LT Pepper Law
LT Pepper Law | Luke T. Pepper
You may have a case here. We would need to evaluate the medical records to determine whether the doctor was negligent when he performed the procedure. You should consult with an attorney before you approach the hospital about who is responsible for the bills.
Answer Applies to: Pennsylvania
Replied: 6/28/2011
Riley Law Firm
Riley Law Firm | Timothy Dennis Riley
The fact that the condition occurred during a colonoscopy does not relieve you of the obligation to pay the bill for the repair. You may have a claim against the physician but perforation of the colon is one of the known potential risks of the procedure which can occur even if the physician does everything correctly. Accordingly, they are exceedingly difficult cases to pursue. On the medical insurance, if your health insurance was provided by your employer (most cases), your options are limited by application of the Employee Retirement Income Security Act (ERISA). You would have to follow the administrative provisions of an ERISA appeal. If it is privately purchased health insurance, you would have more options under the laws of most states. You should consult an attorney in your state with specific expertise in this field.
Answer Applies to: Texas
Replied: 6/28/2011
The Lucky Law Firm, PLC
The Lucky Law Firm, PLC | Robert Morrison Lucky
Thanks for your inquiry. This information is being provided to you based on Louisiana law. Yes, the medical bills still remain outstanding. However, you may make a claim for the medical bills to be paid; however, you will have to bring a claim under the Medical Malpractice Act. Unfortunately, dealing with the insurance company is another story. I would also have the doctor's billing office discuss the charges and the coding with the insurance company. This is a process that is tangled with red tape and usually just requires that you follow the process - although, it is incredibly frustrating. Please contact my office to discuss further. I am happy to discuss all of the issues with you in more depth.
Answer Applies to: Louisiana
Replied: 6/27/2011
Paul Whitfield and Associates P.A.
Paul Whitfield and Associates P.A. | Paul L. Whitfield
Sorry. question is not clear to me. If you think the Dr made an error you must show that by the testimony of another doctor. The problem with billing codes is unclear.
Answer Applies to: North Carolina
Replied: 6/27/2011
    Lacy Fields, Attorney at Law, LLC
    Lacy Fields, Attorney at Law, LLC | Lacy Fields
    That sounds like medical malpractice and you should consult an attorney immediately. You only have two years to file a lawsuit, and you need to get the right kind of treatment immediately. Sometimes if you do not handle these things the right way, the insurance company can make it look like the injuries are actually your fault.
    Answer Applies to: Missouri
    Replied: 6/27/2011
    Vincent J. Bernabei LLC
    Vincent J. Bernabei LLC | Vincent J. Bernabei
    You may have a medical malpractice claim against the doctor.
    Answer Applies to: Oregon
    Replied: 7/11/2013
    The Law Office of Josh Lamborn, P.C.
    The Law Office of Josh Lamborn, P.C. | Josh Lamborn
    You can refuse to pay, but unless you use their procedure for challenging a bill, they will likely submit your bill to a collection agency and ruin your credit rating.
    Answer Applies to: Oregon
    Replied: 7/11/2013
    Law Office of Jared Altman
    Law Office of Jared Altman | Jared Altman
    I am not an expert in health insurance claims. But, it seems to me that if the doctor made an error in the way he/she billed something, then the doctor should eat the loss if insurance doesn't pay. I think that's a great argument, but I don't think that it will hold up in court. Certain injuries and/or side effects are known risks of various procedures. If you suffered a known risk, then you have no recourse. If, on the other hand, the doctor committed medical malpractice on you (which only another doctor of his/her specialty could tell you), then "no", you don't have to pay. Please note the following necessary legal disclaimer: I have not given legal advice. I only give advice to my clients. I am not acting as your attorney. I have not yet agreed to represent you. Anything I have said is based on limited information and may be subject to change as more facts become known. Attorneys express opinions. Attorneys often disagree. If you want further information or independent verification of anything I have said then you should immediately consult another attorney. Never sit on your rights! I am admitted to practice law in New York State only and cannot practice law in any other State.
    Answer Applies to: New York
    Replied: 6/27/2011
    Cody and Gonillo, LLP
    Cody and Gonillo, LLP | Christine Gonilla
    If you are looking to sue for malpractice you have to get the opinion of another medical professional that this set of facts gives rise to a malpractice claim - you should consult with a medical malpractice attorney in your area.
    Answer Applies to: Connecticut
    Replied: 6/27/2011
    Theodore W. Robinson, P.C.
    Theodore W. Robinson, P.C. | Theodore W. Robinson
    About your only recourse is to sue the doctor, but I expect most attorneys would reject such a case due to the minimal nature of it. Instead, you cancall the doctor and explain what has transpired and ask him/her to be reasonable under the circumstances and settle the bill with you for less money since his office played a role in the entire mess. As for the ER costs, that may increase the value of your claim against thedoctor, but usually all medical procedures carry some sort of risk with them and this may be the result of those risks. Good luck. T
    Answer Applies to: New York
    Replied: 6/27/2011
    David F. Stoddard
    David F. Stoddard | David F. Stoddard
    Normally, you are responsible for any bills that your insurance doesn't pay. If some of the bills were incurred because of the doctor's negligence, in theory the doctor should pay those bills. A bad outcome (in this case the burned intestines) is not always the result of negligence. Some procedures have inherent risks of damage that can occur without negligence. As a practical matter, if the hospital or doctor do not offer to pay or forgive the bill, the costs of pursuing a malpractice claim (not the attorney's fee, but the costs of depositions, expert witness fees, etc.) might exceed your medical bills. Your health insurance should pay all of this except deductibles and co-pays.
    Answer Applies to: South Carolina
    Replied: 6/27/2011
    Bernard Huff, Attorney/Mediator
    Bernard Huff, Attorney/Mediator | Bernard Huff
    You need to retain and/or consult with a medical malpractice attorney. The medical bill will remain your obligation until you resolve it.
    Answer Applies to: Indiana
    Replied: 6/27/2011
    Allen Murphy Law
    Allen Murphy Law | W. Riley Allen
    Yes, unless you get someone like a lawyer to help you. Or call the risk management department of the hospital and explain what happened.
    Answer Applies to: Florida
    Replied: 7/25/2013
    Kirshner & Groff
    Kirshner & Groff | Richard M. Kirshner
    Sue the insurance company if they received the proper documentation from the doctor and they still refuse to pay. As for the bills , they probably have to be paid unless you can convince the doctor or the hospital the bills were incurred as a result of the doctor's negligence.
    Answer Applies to: Florida
    Replied: 6/27/2011
    Law Office of Mark J. Leonardo
    Law Office of Mark J. Leonardo | Mark Leonardo
    The question would be whether you are making a claim for malpractice. In situations like this I have had the bills waived as part of a settlement. The problem you may face is that it often takes a long time to resolve these claims and the billing departments eventually turn these claims over to collections and it could affect your credit. It is therefore important when you negotiate a settlement to ensure that they remove any derogatory remarks from the credit bureaus regarding your unpaid medical bills and report the claim as paid in full as opposed to settled in full. Better yet, demand a complete deletion of any derogatory remark.
    Answer Applies to: California
    Replied: 6/27/2011
    Pivotal Law Group, PLLC
    Pivotal Law Group, PLLC | Christopher L. Thayer
    If you have a claim for medical malpractice, you may be able to negotiate and have the bills waived, but that is not an automatic process.
    Answer Applies to: Washington
    Replied: 7/11/2013
    Ewusiak & Roberts, P.A.
    Ewusiak & Roberts, P.A. | Christopher J. Roberts
    It is unfortunate that this kind of behavior goes on. It makes me cringe when I hear that we have the best medical system in the world because we have private insurance. It sure doesn't work that way in real life. You have two separate issues. As it concerns the hospital stay due to apparent negligence, you probably signed something agreeing to pay the charges so until the doctor and/or hospital accepts that they made you incur extra charges due to negligence, you are technically on the hook. If you don't pay, they could sue you and/or damage your credit . In theory you would beat a lawsuit by proving that the charges were the result of the doctor's negligence, but there's no guarantee of that outcome. And your credit would likely be affected regardless of the outcome. Credit agencies are terrible to deal with. Your better course of action would be to pay the charges under protest and then sue the doctor and hospital. You could seek recovery of all charges + your mental and physical suffering caused by the medical negligence. As it concerns the improper charges to the insurance company, it sounds like you've already done the right thing which is to write to the doctor/medical provider and insurance company and to document the error and demand they fix the problem. Before you file a lawsuit, you may want to consider a formal professional complaint against the doctor (procedure varies by state, but most states have a professional licensing board that will accept complaints). You should name the hospital as well. This may get their attention and help fix the problem without the hassle and expense of a lawsuit. In fact, the threat of such a complaint (I suggest you threaten in writing) may get their attention. Insurance companies are also regulated by the states and a formal complaint with the department of insurance or business regulation in your state may help. If all else fails, I'm afraid you'll probably want to contact a lawyer and consider legal action. Sometimes companies and doctors refuse to do the right thing. The court/judicial system exists precisely to offer a remedy for what you are experiencing. Good luck.
    Answer Applies to: Florida
    Replied: 2/21/2012
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