HMO’s, elective procedures, healthcare?
April 14th, 2008 | by admin |
andyw asked:
Someone pgoesto the emergency room of a local hospital, complaining of a sore tongue. That hospital, upon finding out that her coverage is provided by an HMO that the hospital does not have a contract with, refers her to the hospital down the street. At the second hospital, they determine that her tongue-piercing has become infected, and excise the infected tissue under the tongue rather than undertaking an extended course of antibiotics because the excision is a quicker and cheaper resolution. The second hospital then tells her that they will not provide her with follow-up care because her HMO will not pay for “reversing” elective procedures such as tongue-piercing. She calls her HMO and they confirm this. Is there anyone she can sue for something? What can she sue for?
Frank
Someone pgoesto the emergency room of a local hospital, complaining of a sore tongue. That hospital, upon finding out that her coverage is provided by an HMO that the hospital does not have a contract with, refers her to the hospital down the street. At the second hospital, they determine that her tongue-piercing has become infected, and excise the infected tissue under the tongue rather than undertaking an extended course of antibiotics because the excision is a quicker and cheaper resolution. The second hospital then tells her that they will not provide her with follow-up care because her HMO will not pay for “reversing” elective procedures such as tongue-piercing. She calls her HMO and they confirm this. Is there anyone she can sue for something? What can she sue for?
Frank
6 Responses to “HMO’s, elective procedures, healthcare?”
By Angie on Apr 16, 2008 | Reply
Sounds like she got screwed. This is a perfect example of how, if a person had known this would happen before hand, she could have gone in and said she had some other problem and gotten the antibiotics. The hospital should be required to explain EVERYTHING. They should be AWARE of things that will cost people out-of-pocket, and declare it BEFORE they offer the procedure. Typical doctor bullshit.
By warplesnorkle on Apr 18, 2008 | Reply
The 1st emergency room instead of the 1st emergency room would have been true emergency.
The emergency room instead of the emergency room instead of her insurance wouldnt pay so thats why she was aware that she is responsible for anything but that doesnt mean that doesnt.
By Tettypu on Apr 21, 2008 | Reply
She can’t sue anyone! Just find a doctor in her network and have them to prescribe her some antibiotics.
By FLOYD L on Apr 24, 2008 | Reply
sue herself for having her tongue pierced.
By garkam413 on Apr 26, 2008 | Reply
probably nothing . just get better insurance. you get what you pay for.
By zippyriver on Apr 28, 2008 | Reply
An elective procedure is possible the complication provided the doctor would have to warrent excision she needs to make it is determination the infection at which time.