Discharged AMA - challenge Dr. bill?

id10t · 08-26-2004, 07:20 PM

We had to take our son to the ER when he was one day shy of 3 months old. Had a fever, couldn't really settle down for long, not feeding, etc.

ER Doc checks ears, throat, etc. His exact words were "Nothing obvious - like an ear infection, etc." (remember this later) Does a chest xray (nothing) some blood work (nothing). Finally gives our boy some tylenol, and he is able to settle down a little and rest on Mommy.

Doesn't think it is menengitis, since the baby will settle some, just not for long. My wife calls the Peds-On-Call doctor, who happens to be in the next building over doing rounds on newborns. ER Doc speaks with her, she agrees that it isn't menengitis.

BUT... Hosptial Policy/Proceedure states that any infant under 3 months (we were still 18 hours short at the moment from that) that comes in with a fever *must* have a spinal tap done to rule out menengitis. Naturally, we refuse it until we can both be well informed about it, which amounts to the Dr and the nurse telling us it is a paperwork required test for a final rule out.

We ask about refusing the test completely, and she says she'll have to report us to the Dept. of Children and Family - again, due to P&P, since refusing the spinal tap they would have to discharge us "against medical advice" or AMA, and any minor AMA'd gets a visit from the nice folks that work at the DCF.

The Dr, nurse, and social worker all agree that the test isn't medically necessary, but that they are covering their ass. They all claimed that they wouldn't call DCF (they didn't) and that they'd document in the chart supporting our position of refusing the test (dunno if they did or not...)

We take the AMA discharge, call our regular pediatrician, and meet her on a weekend at her own office. Diagnosis ? Massive ear infection in both ears. Apparently, when he calmed down in the ER before, it was because his ear drums ruptured and he got some relief from the pressure. Our boy was never seen by a pediatrician in the ER - just the ER doc. After the fact, we were told that they did not provide emergency pediatric care, but are not allowed to turn anyone away. Funny, 'cause both my wife and I worked in that same hospital for a LONG time (nursing, PT aide), and had *many* patients under 6 months of age.

Anyway, because the discharge was AMA, the insurance company isn't paying the Dr, so we've got the nice $400 bill. I feel he was incompetent, and chose to discharge us AMA not for medical reasons but to cover his own paper work.

How much should I fight this? I feel like I should slap that ER doc around some and just pay him whatever my co-pay would've been if he hadn't DC'd us AMA and insurance paid their portion of it. It seems fair to me... but I'd appreciate words of wisdom...

Mule · 08-27-2004, 05:54 AM

I successfully dealt with a similar situation once by going to the hospital & meeting with a finacial rep. I pulled out my check book & told her if she insisted, I would pay, but if I paid, I would have to sue. She asked me to wait for a minute, came back & told me the debt was discharged.

jm951 · 08-27-2004, 08:52 AM

I had a problem with a misdiagnosis in the ER, but the patient was the wife so age wasn't a factor. She wound up having to have emergency surgery later because of it. So, when it came to bill time from the first ER, I refused to pay. The billing dept got a bit huffy and threatened, I counter threatened. Things stood still for a month or so until I got back the billing from the second doctor with the correct diagnosis. Armed with that I called the first hospital back, spoke with the financial rep that was handling our case, got nowhere again (surprise). Then I demanded to speak with the hospital administrator directly. She refused to put me in contact but gave me her supervisor. Supervisor gave the same runaround as the first and then again, I demanded to speak with the HA. She hemmed and hawed a bit until I told her that either I spoke with him or my attorney would in a malpractice suit. That got the desired results. In the conversation with the HA he started to back his people until I laid out the situation, informed him of the second diagnosis and outcome and that they were liable for malpractice. I politely informed him that his choices were precisely drop the bill or get sued. He agreed to drop the bill which was fairly substantial for 1985. So, make sure you have your paperwork in order and the correct diagnosis from the pediatrician. No med facility is perfect, they try hard but with the specter of a malpractice suit hanging over their every move, they'll go to great lengths to CYA.

id10t · 08-27-2004, 08:52 AM

Hospital is no problem - insurance paid them. Its just the darn ER doc...

jm951 · 08-27-2004, 08:57 AM

Even those guys have somebody they report to. Find out who and take it from there.

BGCarrera32 · 08-27-2004, 10:02 AM

Geez, I don't know anything about ears but I sincerely hope your little guy is o.k...

I think I'd raise a little *hell* in a polite way...

BlueSkyJaunte · 08-27-2004, 10:18 AM

My wife and I were recently mis-diagnosed....THREE TIMES and by three independent doctors....as having "bronchitis" when we really had whooping cough. We both had classic symptoms of whooping cough but the doctors were all ignorant of them.

Interestingly these doctors were all not only incompetent but in violation of regulations that require them to report cases and suspected cases to the county Department of Public Health within 24 hours. In fact, the state provides FREE LAB TESTING for whooping cough--so these turkeys didn't even have the excuse of needing to keep insurance costs down. *********s.

I would challenge your doctor's bill to the furthest extent possible. Good luck, and I hope your son's eardrums heal. I blew out an eardrum over New Year's from a sinus infection and a subsequent plane flight. Painful as hell, and the pain lasted a while as it healed, but it eventually did heal and I suffered no detectable hearing loss.

gchappel · 08-27-2004, 10:29 AM

Not trying to back up the er doc, but they do have to follow their protocols. Meningitis can be difficult to diagnose without proper testing, and certainly is in the differential for a febrile child. Let us say he discharged your son and the next day it turned out to be meningitis. I suspect this thread would then be about the stupid doctor that didn't even follow routine procedures. The er doc would be up to his eyeballs in lawyers, heck he missed the diagnosis- he didn't even follow the written protocols that were in place. Both the doc and the hospital would be sued, lose and pay big time. I find it interesting that this doctor is now thought to be incompetent and should be slapped around some. Examining the ears of a screaming, kicking child is not always easy- child was probably much calmer the next day. It is cases like this that have these guys covering their a** a lot. I have never read- gee I went to the er, got a great doctor and he took good care of me. We can all complain a lot if things are not perfect- so complain away. Er docs are people, just like our mechanics. Most try, none are perfect. Everytime something happens let us just sue away. I just hope there is someone working the emergency room when I really need them.

BlueSkyJaunte · 08-27-2004, 10:40 AM

Quote:

Originally posted by gchappel
I have never read- gee I went to the er, got a great doctor and he took good care of me.

OK, I'll bite:

11 years ago I visited the Urgent Care in Ithaca, NY because I had been suffering from some odd chest pain for 24 hours. The university clinic was baffled so they sent me there. In 15 minutes the doc diagnosed a spontaneous pneumothorax and sent me to the ER. At the ER, the surgeon (a Dr. Agostini, to whom I'll always be grateful) performed a tube thoroscopy which allowed my left lung to reinflate. He even had great bedside manner and showed genuine concern for my comfort and well-being.

I'm probably alive today because of that anonymous Urgent Care doc and my ER surgeon.