Medical care versus you and your insurance company I just read the following article which appeared in the American Motorcyclist Magazine.
Although the focus is naturally to the concerns of m/cycle riders....the concern of the situation is there for everyone.
What happens when the patient's insurance company authorizes a payment to a hospital that it has prior contractual agreements with, but the hospital wants a piece of the accident settlement to cover the discount it normally gives the insurance company?.....It refuses payment from the insurance company and puts a lien against the patient's accident settlement, for the full bill.......Florida!
But if it is successful in Florida, expect it to be a nation wide problem for accident patients that win damage claims and hospitals that don't want to live up to their contractual agreements with insurance companies.
This is the article, May 2005 issue. It is a scanned OCR representation, there may be spelling and grammar differences. Quote:
Jacob Faasse thought he had put the horrific crash behind him and was getting on with his life.
After all, it had been two years since he�d been hit by a van while riding his motorcycle. His life-threatening injuries had kept him in the hospital for a month, but Faasse knew he had medical insurance, so he figured everything would be OK.
He figured wrong.
Now, years later, the hospital is telling him he has to pay his outstanding medical bills himself, refusing to accept payment from his insurance company.
The horror started in January 2003, when Faasse, now 59, was hit in Fort Myers, Florida, by a van that made a left turn just 10 feet in front of his 1982 Honda Gold Wing.
Faasse, a school teacher at the time, suffered cardiac arrest, respiratory failure, a shattered left wrist, a compound fracture of the right leg, a crushed throat and other trauma.
It�s a miracle he survived.
Faasse spent a month in the hospital, then went through a long recovery process. During the ordeal, his injuries forced him to retire from his job.
He has high praise for the doctors who saved his life and for the care he received at Lee Memorial Hospital. And he sincerely wants all his medical bills to be paid.
In fact, he says, the doctors filed for payment from his insurance company and have been paid. But the hospital refuses to follow that course.
Instead, the hospital
wants a piece of the settlement that Faasse received from the van driver in the crash.
Why would a hospital turn down payment from an insurance company and go after the patient instead? Simple�the hospital wants more money.
Lee Memorial Health System�s contract with Faasse�s insurance company provides for caps on payments for various services. So if the hospital sends the bills to the insurance company, those limits would apply.
But if Faasse himself has to pay the bills, there are no limits, and the hospital is free to charge substantially more.
In their effort to get those higher payments, hospital officials have simply refused to send Faasse�s bills to his insurance company, which is prepared to pay the claim. Instead, they have filed liens for more than $143,000 against the settlement Faasse received. As a result, that money is now tied up in escrow.
And incredibly, that has left Faasse in the position of having to file a lawsuit against the hospital to force it to accept insurance payment for his bills.
Faasse�s suit notes that although the Florida Legislature gave Lee Memorial Health System the power to file liens so it could collect payment from patients, it allows that only in cases where those patients don�t have medical insurance to pay their bills. And he says the hospital is abusing its power, because Faasse has insurance.
�They have a right to put a lien on me,� Faasse says, �but not to refuse the insurance payment.�
You may be thinking that this can�t happen. Surely, it�s just some mistake. But if it is, it�s a mistake this same hospital has made a number of times.
In late February Scott Whitaker, 29, who was injured in a car crash in September 2003, filed a lawsuit against Lee Memorial Health System after the hospital placed a $37,328 lien against Whitaker�s uninsured motorist insurance policies.
In another case, Tiffany Giddes, 22, of Fort Myers, received a settlement as a result of a 2001 car crash that left her forced to use a wheelchair for mobility. The hospital has filed $99,790 in liens against the settlement rather than seek payment from her insurance company.
Wbitaker hopes to turn his lawsuit into a class-action suit on behalf of patients. That lawsuit seeks to force the hospital to honor the agreements it has signed with insurance companies, rather than seeking higher payments directly from victims.
�Lee Memorial is taking money (it�s) not entitled to, and that�s money out of the patient�s pocket,� Whitaker�s lawyer, Joseph Fuller, told the Fort Myers News-Press.
The hospital, however, defends its actions.
Regarding the Faasse case, Robert McCurdy, the hospital�s vice president for legal services, told the News-Press:
�The amount of money that�s available through health insurance oftentimes is far less than the total amount of the bill. The question is, should Lee Memorial be entitled to recover the money it�s spent on this gentleman?�
Faasse sees his lawsuit as the only way he can make sure the hospital gets paid, the liens get removed and he can �get on with my life.�
But he has some advice for motorcyclists and their families who may find themselves in the hospital being badgered to sign legal documents: Don�t sign anything without reviewing the documents with a lawyer.
Hospital officials, he says, �wanted my wife to sign papers that said if I didn�t pay the bills, they could go after her.�
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