Cost of complications

[Cmd6715 5]

I was self pay at a surgical center and had to go to a hospital 10 hours later for another surgery because of internal bleeding(nicked artery), needed several transfusions and spent 3 days in the hospital plus had to have more blood and Iron transfusions after leaving that hospital. I’m now stuck with over $175,000 in hospitals bills and more still coming. BCBS is denying the claim because they don’t cover bariatric surgery or complications. The hospital billed it as complications of lap band instead of complications of gastric sleeve. I’m told it doesn’t matter because they won’t pay either but what if I want to appeal it, shouldn’t it be billed correctly?

[SleeveToBypass2023 2,598]

17 minutes ago, Cmd6715 said:

I was self pay at a surgical center and had to go to a hospital 10 hours later for another surgery because of internal bleeding(nicked artery), needed several transfusions and spent 3 days in the hospital plus had to have more blood and Iron transfusions after leaving that hospital. I’m now stuck with over $175,000 in hospitals bills and more still coming. BCBS is denying the claim because they don’t cover bariatric surgery or complications. The hospital billed it as complications of lap band instead of complications of gastric sleeve. I’m told it doesn’t matter because they won’t pay either but what if I want to appeal it, shouldn’t it be billed correctly?

A couple of things. I have never heard of anyone having a sleeve and not spending 1 night in the hospital. It was done as a same day procedure?

And it should have been done in a hospital. Was it done in a surgery center and not the hospital? If so, why?

When I had my sleeve and later my revision to bypass, BCBS paid for both. Why did they not pay for yours? Typically if you're self pay, insurance won't pay for any care pertaining to that procedure if it was something they already wouldn't cover.

Have you reached out to the surgeon who did your surgery? What did they say about the complications? And I guess I'm confused about how an artery was knicked and nobody noticed for 10 hours.

And yes, if you had a sleeve and it was billed as a lap band, it most definitely needs to be corrected.

[nkta6487 12]

Definitely reach out to the surgeons office bc BCBS tried to pull it saying it wasn’t covered but it actually was I had already checked before going through the program

[Cmd6715 5]

Sleevetobypass2023- Yes they did the sleeve at a surgical center (very common in Florida) they have private staff to keep you over night but at 10:15pm when it was time for me to walk again I was dizzy and my BP was low so they called my husband and told to drive me to the hospital that my surgeon text him the info for. By the time I arrived at the hospital I had already loss 2000cc of blood and looked 9 months pregnant.

As far as the surgeon he said he is sorry, these things happen and there is nothing he can do. He won’t even help have the hospital correct the billing codes.
BCBS told me they don’t cover any WLS or complications from it but they paid to remove my lap and 3 years ago.

[summerseeker 2,138]

This sounds like the surgeon is distancing himself as far as he can. For goodness sake they didnt even get you an ambulance ! You may need to speak to someone to start a negligence claim. I am so sorry this happened to you.

[catwoman7 11,212]

this is so awful. I am so sorry this happened to you. This was one of the things that scared me about plastic surgery (which is usually self-pay - if insurance covered it, I wouldn't have been as concerned). I opted to pay more for a plastic surgeon who did it in a hospital and insisted his patients spend the night there, too, so they could monitor me in case anything happened (although even though it gave me some peace of mind, it probably wouldn't have helped money-wise -I'm sure I, too, might have gotten a huge bill if something like this had happened to me). I don't know what to say other than this is just awful. I wonder if talking to the hospital's billing dept might help - maybe they'd be willing to reduce it? (I don't know since I haven't been in that situation). But how can they expect anyone to be able to pay that?

[ShoppGirl 4,785]

I wonder if you would qualify for some financial assistance. I mean even though you may not qualify otherwise and you have insurance, that’s a large bill for most people and you are self pay in this case. Did the hospital warn you that insurance may not pay. I mean if they let you believe they take your insurance you would have no reason to anticipate a bill like that. Don’t they usually warn you if things won’t be covered? I guess that may be different given it was a very urgent case but, I would do a little research to see what laws apply in your specific situation. Them “accepting” you insurance but providing non covered care without warning you.

[Cmd6715 5]

ShoppGirl- I went from ER to operation room and then was out of it for 3 days so they didn't say anything at the hospital about billing but when I contacted the billing department, they told me that they got preapproval from the insurance for admission. They refused to submit the bill with the correct codes and referred me to a company that would decide if I qualify for financial assistance.

Edited October 6 by Cmd6715

[ShoppGirl 4,785]

1 hour ago, Cmd6715 said:

ShoppGirl- I went from ER to operation room and then was out of it for 3 days so they didn't say anything at the hospital about billing but when I contacted the billing department, they told me that they got preapproval from the insurance for admission. They refused to submit the bill with the correct codes and referred me to a company that would decide if I qualify for financial assistance.

You have to keep on them. Tell them if they got “pre approval” then you want the pre authorization number to call the insurance and give to them so they can pay it. Ask for the BOD or whoever is the higher up at your hospital. They don’t want to do more work rebilling but you only have so much time to appeal things before it’s too late. Also ask insurance how you can get to start an appeal on your own. I had a bill that my local doctor didn’t get prior approval for the procedure so it wasn’t covered but should have been because it was medically necessary and I had to fight for like 6 months until they finally wrote it off and that was only like 5 grand. I called three times a week to see what they were doing to rectify it. I actually used my headset and walked back in forth in my house while I was on the phone to get my exercise in when I was post surgery. Keep detailed notes of everyone you call, email, leave vm, etc with dates.

Edited October 6 by ShoppGirl

[SleeveToBypass2023 2,598]

So #1 is you definitely need to fight to get this rebilled properly. It's insane to me that they won't fix the billing. They get paid more for the proper procedure, so that's crazy that they won't fix it.

Then #2 is you need to contact someone about starting a lawsuit. The surgeon should have called an ambulance for you. The surgery should have been done in a hospital. You should have been monitored closely and been up walking within 2 hours of being out of recovery and back in your room. Knicking an artery could have literally killed you and definitely should been noticed before 10 hours.

Finally #3 is getting this covered by your insurance. BCBS should be covering any lifesaving, medically necessary health care and procedures. No, they won't cover care for non covered procedures, but that's usually just follow ups and complications of the NON LIFE THREATENING variety. Everything you've been telling us falls into the life threatening, surgeon negligence, medically necessary to SAVE YOUR LIFE category and should be covered. You need someone to fight on your behalf to get this stuff covered and either greatly reduce or even completely eliminate your bill.

I'm from Florida, and while it might be done in some places to have a surgery like this in a surgery center and not a hospital, it's definitely not the absolute norm. Did you do extensive research on this surgeon, his reviews, compare him and his pricing to other surgeons? No way would I have had this surgery and NOT been in a hospital. Too many things can happen when you least expect it.

This guy distancing himself from all of this, when clearly he screwed up, is the first HUGE red flag. Refusing to fix the billing error is the 2nd one. Not calling an ambulance and instead having your husband take you (effectively making it appear that you left on your own and went to the ER instead of him seeing an issue while under his care and calling an ambulance for you, so he can wash his hands of it and look like whatever happened was on YOUR watch and not his) is a 3rd red flag.

[ShoppGirl 4,785]

I didn’t even think about the fact that they had him drive you. I have heard of some people getting the surgery as an outpatient although I don’t think it’s very common but yea @SleeveToBypass2023 is right. They even wasted precious moments waiting for your husband to get you there while you were essentially bleeding out. The purpose of an ambulance is to get you there quicker and have care in route. I mean if the Dr couldn’t help you then surely your husband couldn’t while he was driving. That was a really bad call on their part.

[Cmd6715 5]

Yes I checked the reviews and they were good, he was the surgeon that had trained the surgeon that did my lap band years ago. He was late that day and I was the first patient of 7 so maybe he rushed through my surgery or maybe it was something to do with his finger injury a month prior.
The surgical center said “your blood pressure is a little low so the surgeon wants you to spend the night at the hospital as a precaution, he will text your husband the address of the hospital to meet him at” so looking back yes I think they downplayed it to get me out of there.
On the way I kept passing out. The hospital he sent us to was 49 miles away because apparently he doesn’t have rights anymore at the one that was a few miles away. I had asked his office staff previously what happens if there are complications and they said the surgical center is close to the hospital.

A lawyer won’t touch this because the Dr. doesn’t have malpractice insurance (that’s something I kick myself for not knowing and hopefully anyone reading this learns from my mistake) and they say I don’t have permanent injuries from it. You would think with the trauma, stress and all the bills even besides the hospital bills, the hematologist, cardiologist, paying for someone to help take care of my specials needs daughter, the extended recovery time would matter but it doesn’t.

Thank you both for the advice on the insurance and what to do with the hospital billing department. I get on all that first thing tomorrow.

[ShoppGirl 4,785]

2 hours ago, Cmd6715 said:

Yes I checked the reviews and they were good, he was the surgeon that had trained the surgeon that did my lap band years ago. He was late that day and I was the first patient of 7 so maybe he rushed through my surgery or maybe it was something to do with his finger injury a month prior.
The surgical center said “your blood pressure is a little low so the surgeon wants you to spend the night at the hospital as a precaution, he will text your husband the address of the hospital to meet him at” so looking back yes I think they downplayed it to get me out of there.
On the way I kept passing out. The hospital he sent us to was 49 miles away because apparently he doesn’t have rights anymore at the one that was a few miles away. I had asked his office staff previously what happens if there are complications and they said the surgical center is close to the hospital.

A lawyer won’t touch this because the Dr. doesn’t have malpractice insurance (that’s something I kick myself for not knowing and hopefully anyone reading this learns from my mistake) and they say I don’t have permanent injuries from it. You would think with the trauma, stress and all the bills even besides the hospital bills, the hematologist, cardiologist, paying for someone to help take care of my specials needs daughter, the extended recovery time would matter but it doesn’t.

Thank you both for the advice on the insurance and what to do with the hospital billing department. I get on all that first thing tomorrow.

Maybe check the hospital website so that you can get the person’s name that you need to speak with so when you ask for them by name, it holds a little more merit than just asking for a supervisor like genetically. And if they won’t put you through then just send something in writing usually things in writing (email). Usually they have to respond to that because you have proof you sent it. Good luck.

Edited October 6 by ShoppGirl

[SleeveToBypass2023 2,598]

WHAT??!?! He doesn't have malpractice insurance??? Oh hell no. I found a few lawyers in Florida that will take the case even though the doctor doesn't have insurance. The statute of limitations is 2 years, so you're good to go there. Here's the links to the lawyers. Call all of them and get a free consultation with them. They will tell you what you need to do, what they will do, how long it should take, and what kind of compensation you can expect.

https://www.perry-young.com/?gad_source=1&gclid=Cj0KCQjw6oi4BhD1ARIsAL6pox2H1RUUkv-VXgcfBbAksyMeFDaTMZ6Ep9HFEXbKqDEgzTx2J1307W8aAnTCEALw_wcB

https://floridamalpractice.com/?gad_source=1&gclid=Cj0KCQjw6oi4BhD1ARIsAL6pox1o4nA9JWNZbORzJEo4vP10_Aq73CpQmezeIW5dlOW8vlE-ZDGShzwaAiLtEALw_wcB

https://grossmanattorneys.com/florida-medical-malpractice-law-firm/

https://www.anidjarlevine.com/faqs/can-you-sue-a-doctor-without-malpractice-insurance/

And of course the KINGS of all things personal injury: https://www.forthepeople.com/practice-areas/medical-malpractice-attorney/

[ShoppGirl 4,785]

1 hour ago, SleeveToBypass2023 said:

WHAT??!?! He doesn't have malpractice insurance??? Oh hell no. I found a few lawyers in Florida that will take the case even though the doctor doesn't have insurance. The statute of limitations is 2 years, so you're good to go there. Here's the links to the lawyers. Call all of them and get a free consultation with them. They will tell you what you need to do, what they will do, how long it should take, and what kind of compensation you can expect.

https://www.perry-young.com/?gad_source=1&gclid=Cj0KCQjw6oi4BhD1ARIsAL6pox2H1RUUkv-VXgcfBbAksyMeFDaTMZ6Ep9HFEXbKqDEgzTx2J1307W8aAnTCEALw_wcB

https://floridamalpractice.com/?gad_source=1&gclid=Cj0KCQjw6oi4BhD1ARIsAL6pox1o4nA9JWNZbORzJEo4vP10_Aq73CpQmezeIW5dlOW8vlE-ZDGShzwaAiLtEALw_wcB

https://grossmanattorneys.com/florida-medical-malpractice-law-firm/

https://www.anidjarlevine.com/faqs/can-you-sue-a-doctor-without-malpractice-insurance/

And of course the KINGS of all things personal injury: https://www.forthepeople.com/practice-areas/medical-malpractice-attorney/

It definitely couldn’t hurt to check with different attorneys. It’s just about their judgement as to whether they think they can win the case and like everyone In life some are all about the money but some actually care about justice. You should be able to find one that wants justice for you. I mean had they called for an ambulance right away and sent you to the closest ER you may not have even needed such extensive care. I think in medical claims they have another doctor review it to see if they did everything they should have. I’m not a doctor but it doesn’t sound like it from what you’re saying.

Edited October 7 by ShoppGirl