Doctor's Office Won't See Sick Son

1) You have no legal case--no damages.
2) Your insurance issues are YOUR responsibility to clear up.Investigate the issue instead of suing a doctor--what relationship would that make?
3) Why weren't you offered the opportunity to pay cash and wait for the insurance sort out?
4) Doctors do not have the time to talk to every patient who has insurance issues.
5) If this office was rude, it is time to find another office.
6) Many doctors run a tight budget...they can't afford to carry a lot of balances. They pay staff, and student loans etc.
7) It is awful that you waited a few weeks and still haven't done your part to solve the issue--typical response--sue the doctor. That is why they are so concerned about coverage.

4 moms found this helpful

M.-

I am sorry that this happened to you - and I am actually able to respond from the office perspective as I've managed physician offices for many years.

1) They should have offered to see your son as a "self pay" patient - while you sorted out the insurance situation. My staff had been instructed to NEVER turn away a sick patient irregardless of ability to pay; insurance coverage etc... If there was any question - they were to come get me.

2) Insurance companies have a contract with their providers - and they are very interested in hearing about issues dealing with service; refusal of service, etc... so I would contact your insurance carrier immediately - find out what their customer service number/address is - and send in a note - written objectively -state only the facts - and they will initiate an investigation. Physicians can be disciplined for their behavior and also for any repeated negative behavior of their staff. This most likely isn't an isolated incident - and they should hear about it. They have been known to cancel contracts based upon patient complaints. If it's a big carrier - it can be detrimental to a physician practice if that happens.

3) I hate to say it - but even though the physician may not have known about this particular incident - they usually are aware of customer service issues with their staff. If the staff continue to remain the same - it reflects on the physicians desire not to improve their service. Although they are having a meeting to address it - without management buy-in - it won't change. If you have to go to the last resort of having a physician paged every time you want to talk to them - as the office won't give them your message - it's very poor service - and truly makes me cringe. I believe that at this point you are better off seeking a new practice - and physician. As you look for one - know that most - will allow you time to come in and ask questions either with the manager or the physician - in regards to practice style etc... One of the questions that I would ask - is give them the example of what just happened with your insurance and ask how they would handle it. If they don't tell you that you would have been seen - I would steer clear of that practice.

Sending a patient to the ER is truly not a best practice - it floods the ER with unnecessary patients - and generates a much higher bill for the patient. I am appalled that they suggested this.

Good luck - sorry so longwinded! But I believe that those of us in health care - are first and foremost patient advocates - and the practice truly let you down.

P.

3 moms found this helpful

Did the office staff at least offer to you the option of paying out of pocket and then having you submit your claim for reimbursement to your insurance company? That's what I would have done in your situation (assuming that you had already called your insurance company and verified that your insurance was active and that they would cover the visit.)

I do not believe there is any legal liability for the office, as it is a clinic setting-not an ER. That is why the office staff directed you to take him to the ER if you could not provide proof of insurance to the office. I am sorry to say, but I believe the onus was on you to get your insurance matters settled before requesting that the doc see your son in the clinic. You should have taken him to the ER.

2 moms found this helpful

Doctors offices don't have to accept our insurance, or any insurance, and they don't have to submit the paperwork for reimbursment... they do it to be competitive. As the patient, it is your responsibility to make sure you pay for the service you are receiving. Did you offer to pay cash for the visit and then submit for reimbursement on your own?

2 moms found this helpful

I agree that the doctor should have say your child, you have just paid cash and dealt with your insurance yourself but a doctor can choose he or she wants as a patient. If you were not willing to pay cash they have the right not to treat your child. I do realized you said you have insurance but the clinic felt you did not.
There are many doctors that will not see families that do not either have the correct insurance or do not have insurance at all. i do not think that you have a legal case against this doctor because they have a choice, just as you have choice to go to his clinic or not. They did give you an alternative option to go to the emergency room. You could also have went to any urgent care clinic that is covered under your insurance. Again I will say I agree with you, the doctor should have saw your child but on the other hand, do you really want your child seen by a doctor that does not want you at their clinic. I think I would be searching for a new physician for my children and quick. If I got a call from the doctor that said, you need to follow the rules. What rules, you have the right to pay cash when you see the doctor. Even if you really liked this doctor, it also sounds like this clinic/doctors office is all business and not worried about you children. Get a new doctor and quick..

Good Luck

2 moms found this helpful

PLEASE if your child needs insurance, look into Kid Care.

Private doctors offices do not adhere to the same policies as hospitals. Without insurance go to the nearest ER for treatment. They handle things like that all the time.

I would hate to be in your shoes. Please look into kid care. It is one thing if we as individuals who are working have no coverage (yes still dangerous but, we are adults). Get your kids some kind of coverage through the state. All kids in Illinois are eligible for coverage on sliding scales and in some cases free. It is early in the year but, it is flu season.

I am so sorry your pediatrician's office stinks. The least they could have done was told you about their policy in a kind and thoughtful way. NO doctor likes this but when they work for someone and it isn't their private practice...they have rules to adhere to.

Best of Luck,
D.
Mom to 4 y/o, and 10 m/o triplet girls

Best of Luck

2 moms found this helpful

I agree with posters KateJ and JC...if your insurance is still not "active" then it's you who needs to call the insurance company immediately!!! If your doc's office doesn't accept patients without working insurance that aren't paying in full at the time of service I think that is legal. Stop stressing out about the doc's office...I'm sure you and the office staff could've handled the situation better, but it's over now. I would definitely recommend you find a new practice, though, because you don't need to revisit those bitter feelings every time you go in to see the doc...and with little ones in our lives and winter fast approaching it seems like we spend A LOT of time and money at our pediatricians office, so you need one you like and can trust! We go to
Children's Medical Group...Lake in the Hills
www.childrensmedicalhome.com
Love this practice!
Good Luck!

1 mom found this helpful

I dont understand why you havent called your insurance company....you say you called the Dr office 6-8 times but never called your insurance........if you have insurance then you should have taken your anger out on them instead of the Dr office....you said "fast forward a few weeks" and your son gets sick again but you still havent contacted your insurance company i am baffled ........i would have been on the phone at the Dr office with the insurance company & got it taken care of immediately....although this is new insurance if its active it can be used immediately.....I am sure the Dr knows you have been calling and told the office manager to take care of it.......

1 mom found this helpful

And edited to add - if this poster doesn't like your response, be prepared for a private message such as the following (and, quite different from the original posted response):

"MR

You missed the point tho -- we HAVE insurance. Always have had insurance! And yesterday the office manager refused to let me talk to the doctor. I wasn't even looking to come n. I just wanted to talk to her about my son's illness."

Your first thought shouldn't be about a legal case.

Your first thought should be finding a clinic that you can afford. Nowadays there are several option so you should be able to find one rather easily. If not there is always the ER. And, as others have mentioned there are ways to insure your kids through our state if you need it.

Although you may find the treatment to be unacceptable, a private physician does not have the responsibility to treat a patient who does not have insurance or does not have the ability to pay.

You probably do not have a case, but if you're willing to invest the time, money, energy, and resources you might at least be able to learn more about the process.

1 mom found this helpful

I'm sorry M., I'm sure this is very upsetting to you!If your son is very sick, instead of waiting for a call, take him to the hospital or a 24 hour clinic and have him seen right away.
Private Practice Physicians are not subject to the same rules as hospitals/emergency rooms. It doesn't appear you have a case here. You could always consult an attorney to be sure, but your time might be better spent finding a doctor that you get along with, that has the ability to see your son when needed.
I hope your son is okay.
VickyM

1 mom found this helpful

You don't have legal grounds for a lawsuit....in order to sue for malpractice you have to show damages. Only certain kinds of damages are compensable and indignation and inconvenience do not rise to the level of compensable damages. You need to straighten out your insurance situation and then find a new doctor. Good luck.

1 mom found this helpful

M.:

My heart goes out to you. This may be a wake up call that you need to find a pediatrician and staff that cares about the patient. I have been in the medical office/insurance for 22 years and this office needs a "wake up call".

At the very least, they could have asked you to pay at the time of service and send in the claim yourself. At the very MOST, they should have "put the patient first" and do what they "ethically" should do.

Many times the office staff is the reason why doctors lose patients, as they are the first face you see. With TRAINING on Customer Service, they can accomplish their job and SERVICE the PATIENT. It is sad.

My recommendation is to send a letter to the HOSPITAL that they are affiliated with, referencing your concerns. There is no one there that opens their mail or goes through it. Mark it "CONFIDENTAL".

I understand what their goal is, however they handled this very poorly.

If you are anywhere close to Buffalo Grove or Evanston, I highly recommend North Suburban Peds. They have taken care of my child for 16 years. I am a medical snob and have expectation, I know the ropes - what is appropriate and what is not - this is NOT!

My best to you.

S. H - Grayslake.

1 mom found this helpful

I would switch doctors but I also don't think there's anything legal you can do. The police didn't call back because this is a civil matter and not anything they would become involved in. Basically, the office you take him to can have any policy they want and if you're not able to go by that policy, they do not need to see you. For instance, they may only be accepting patients, new or not, with proof of current insurance. You do have medical care available, the ER. Preferrably not where you want to go but they will at least see you. Private doctor offices have much different policies to follow than public/community hospitals. I'm assuming they're acting this way because they have gotten burned by a lot of people with the economy the way it is. Likely, they changed their policies and have gotten very tough with enforcing them. Basically, take him to the ER. Don't keep him from receiving medical attention because of your issue with this office. If he's sick, he's sick and needs to be seen. It sounds like you have more of an issue with the office than your child being sick. Plus in 3 weeks you should have been able to get this worked out with your insurance company. And there are many doctors you can take him to who will take him that day or the next even as a new patient.

1 mom found this helpful

Sorry but I don't think you have a legal case. If you dont't have insurance (or not showing coverage) then unless you pay for the visit upfront then wait to be reimbursed then they don't have to see you.

1 mom found this helpful

You don't have any legal footing so don't waste your time with a lawyer. The previous poster was correct, you should have been offered the option of paying out of pocket and submitting for reimbursement yourself. You should take care of your insurance situation right away rather than worrying about sueing somebody.

1 mom found this helpful

Not sure what kind of legal case you could have here other than that you can accuse them of being rude, inconsiderate, nasty and dumb. So the next thing is can't you call the insurance co and find another doctor? I have had rude doctors, rude dentists and so on. There are usually alternates provided through your insurance carrier.
You could complain to the Better Business Bureau, American Medical ASsn. and so on. I found it takes a lot to get their attention (Believe me I have story after story to tell you if you want to hear any).
The legal issue would take place if you lost your child or there was some sort of neglect and even then it has to be proven all over the place.Since the child never saw the doctor, there is no neglect and if they have their rules it's difficult to get around that. Now there is something called the hypocratic oath (spelling?) or whatnot that the doctors are supposed to take when they get their license or doctor paper but I will say that that is appearing to not be the norm. (You know where they say they will take care of patients regardless of money or not). And having insurance is a little better than not having insurance as the level of rudeness seems to go down a little if you have insurance. If you don't I have been treated like a homeless person. I'd say to start over. I am sorry your son is sick. Been through these types of things many times and it is horrible. In some cases the doctors really don't know you are being treated like that. Please look for another doctor. Best thing is to pray for these people. They really need it.

Their policy makes no sense to me, but I doubt you have a legal case.

The experience you're describing would cause me to change docs even though you like the doctor. If she is in private practice, she should know how her office manager is handling things. If the office manager is still working there and gives you any amount of grief again, you should change docs immediately. I personally would change docs anyway because I wouldn't trust the office. I know that with some insurance you have to fill out forms and can only change once per year, so look into yours and find out what you have to do. You can also report the office to the Better Business Bureau, since this is more of a bad business issue than a legal issue.

Any time there has been an issue with our insurance, the doctor's office has billed us directly and then we take it up with the insurance. This happens once a year when our insurance company puts a hold on a claim to make sure we only have insurance through them (for instance -- when I broke my ankle they wouldn't pay until we explained the circumstances because they wanted to know if it should be covered on some one else's liability insurance). It's annoying, but a doctor has never refused to see us. Generally, the doctor's office doesn't know about our insurance situation until they bill us. If your cards were expired, a quick call to the insurance company should have been enough to verify your policy was current. Or you could have asked them to bill you directly and signed something claiming responsibility for payment.

I would call your insurance company right away and get them involved. I have had all kinds of weird paperwork issues over the years at my old doctor's office, but I have NEVER heard of that either- especially if your son and family have been going there!! Can you talk to the doctor or the nurse on call directly? Maybe there is a new office manager who is just a stickler for the bottom line?? Either way, there is no excuse for that kind of treatment. I cannot believe the person below who posted that a private physician has no obligation to treat or see a sick child who may not be able to pay them.

Do doctor's NOT have to take the Hippocratic Oath anymore?? That's news to me! If that's really how this doctor feels about it- leaving a sick child who is a regular patient sitting there in the waiting room- then they are obviously only in it for the money and not about healing the sick at all.

Find out who actually OWNS the office- whether a doctor, medical group, hospital corp, etc. and start writing detailed letters of complaint, so your complaint is documented. Get a letter from your insurer explaining the situation and copy and attach that too. Very often the actual doctors at a practice are TOTALLY clueless of these kinds of staff issues- they sort of remain above it. And if the practice is part of a larger hospital or medical company, they won't ever find out how this office manager treats people unless you tell them about it.

Do you know anyone else who goes there? SHARE YOUR EXPERIENCE! If I knew who it was, I would certainly not take my family there! People below who make this into 'your fault' are full of it. Sorry, but we pay doctors and insurance company a lot and at the very least deserve basic politeness, helpfulness and good customer service. You have to vote with your dollar on this like anything else. Having been to a very bad family practice and a very good one, I can tell you personally that GOOD DOCTORS will be involved with your insurance issues and either answer your questions or direct someone on the staff to help you out. The office manager or desk staff are supposed to be giving CUSTOMER SERVICE to patients- at a bad practice they seem to forget that a lot.

A good practice will take the time to help you with ALL ASPECTS of your family's medical care- there is no way to separate insurance from that, no matter if some people try to act like the two have nothing to do with each other. You would not put up with bad, neglectful service from someone working on your car or home- why on earth should you have to do all the work and be treated rudely at the doctor's??

I do think you may have a legal case here- at the very least, it makes the entire practice look VERY BAD. I would contact my insurer and find a new practice right away!!!

This is exactly the kind of situation ordinary people find themselves in that causes health care costs to go through the roof- your child needs his regular doctor, not an ER visit! Too many times, even children are deined basic care because of some kind of paperwork mix up or staff who just don't want to be bothered to do something extra, etc. You have been paying all of those expensive insurance premiums so your son would have care and to AVOID exactly this kind of situation- it would be unbelievable if it didn't happen to so many people.

I would be hopping mad- I don't blame you a bit. Go get 'em and I hope your son is better!!

Hi M.,

If I were you I would try to get some legal advice, because your situation could have ended horribly. However, before you seek legal advice maybe you could speak with someone at the hospital who deals with concerns and questions related to service.

All the Best!

Sorry, but you don't have a legal case here - unless you can show damages, forget it. Even when you can show damages, it's not east to find an m.d. who will testify against another m.d.
That said, I would absolutely find a new pediatrician. Your doctor can say whatever she likes, but I doubt you are the first patient who has been treated this terribly by her staff. Personally, even if I knew that all of the appropriate staffers has been reprimanded, I would still be reluctant to go back to this office. Maybe by losing a patient (or many?), this doctor will realize how important it is to have an professional AND empathetic staff.
Also, as others who've responded have suggested, I would call your insurance company immediately to find out what the holdup is - unless you're insurance just wasn't in effect at the time of the doctor's visit, there's no reason you shouldn't have been in the insurance company's system.

i don't know if you could legally do anything but i would report the office to the state of illinois. there has to be a regulatory office that handles complaints like that. regardless of insurance, why wouldn't they just expect a patient to pay out of pocket? definitely not a legitimate situation. maybe they thought you were trying to commit insurance fraud and it's a big misunderstanding? regardless, they didn't handle it properly and i'd say it's time to move on.

First thing I would do is change doctors. I have heard of offices refusing to take more medicare or medicaid patients but never people who just didn't have insurance. As long as you tell them you would pay out of pocket if your insurance didn't cover it I don't understand their policy.

Hi M.,

I'm sorry that you had to go through this with your son. I see this all the time in hospitals. And although they say that you cannot be discriminated because of your insurance it is a bunch of bologne. If your ped's office is part of a hospital they should have a "patient relations" department where you can file a formal complaint. I wish you the best of luck and hope your pediatrician will take care of the issue like he/she said they would.

Who is your pediatrician? I'm hoping it isn't mine.

Put them on the list of places on mamasource. they ask about Dr 's and businesses. We love the bad remarks it keeps us away from these places. Take him to the E R that is why our insurance is so high. They can refuse you at the office but not there. Be sure to be prepared for a wait, alot of other moms will be there for the same reason. Children are dieing from the swine flu. But they can live if they have the proper insurance WHAT A CROCK. I have great insurance, but I feel your child deserves the same care as mine. Maybe I now get what Obama is saying.

I'm not positive it's the right place to start, but the Illinois Department of Professional Regulations manages licenses for all physicians, along with a lot of other types of professions. Good luck.

Hi M. First of all take your child to the emergency room to see what wrong with him and find another peditrican for him. I have never heard of anything like this either. Contact the medical association and see what the protocal is. Because it sounds like they only care about money!!! not the welfare of the patient.

M.,
If I am hearing right you HAVE insurance but the processing is in error. I was in this situation recently and it is very frustraing. My son was denied services with an Orthodontist office who themselves made errors in billing.I can empathize when this causes anxiety, especially when it is a case of being sick. In my son's case he had a wire poking him for a week and it was painful. I am still in this situation somewhat as my doc office kicked out my insurance and needed to reverify it.

How did I handle it? I too had office staff who were not understanding for the orhtodontics (Don't got to Dental Works of Sears). If it is a medical group or a corporate one they have higher up offices you can refer to.

I had to call the provider (my husband's benefits center) and get on a 3 way call as one way of verifying coverage. When I pointed out the call was being taped, they then offered to keep the appointment they had earlier cancelled as my son was in discomfort. They other thing I did was contact the insurance company and again did a 3 way call to get the people who ultimately needed to communicate because the errors of others were errors that I could not fix.

I hope this helps some. It is sad how much time something like this can take up. On the otherhand if a doc office tells you to go to the E.R. and you have insurance then even if it is not fixed right and you know it will be, the insurance should pay. I know there are cases where this may not be true depending on what you are going for. Ultimately, hopefuly your son is fine now.

IN terms of a legal case, I am not sure.

Best of luck,
M.

I don't know if you have a legal case here, I was just blown away while reading this. Personally, I would start by finding a new doctors office. There is no way I would go back there even when the insurance issue is handled. I think there are legal services you can call to get free advice. They let you know if you have a case or not. I'd try looking into something like that.

I am not sure if you have a case or not. The federal laws are very specific when in an ER, but I am not sure if they cover you in a clinic. That being said, why were you not looking for a new physician before you child got sick again? This behavior is unacceptable and you should report it to the state. Dump this group and tell everyone you know about it. Bad press can be devasting for a doctor's practice. While I know that medicine is a "business" there is still no reason for a doctor to send you to a crowded emergency room when you are in his/her office. I agree with the mama who stated they/you should have been offered to pay and submit to your new insurance.

It would be best to contact an attorney who specializes in malpractice as state laws can vary. You also can check medlaw.com but it would be best to verify the information you find with an attorney.

That's awful. Switch doctors! I'm sure the doctor sets the tone for staff attitudes, so I doubt speaking with her will resolve anything.
I can't believe you were referred to the ER. That's just ridiculous. At the very least, you should have been offered the option to pay in full or been referred to immediate care. And the refusal to allow you to speak with the doctor is even worse.
I doubt you have any legal recourse, but even if you did, doubt you would want to waste your time. You can, however, find a doctor review website and post a review so that others will be forewarned.

For the health of your child go to the er or urgent care place. Then further deal with the situation. If they treat you that way, I wouldn't want to go back anyway. Find a new doctor.

Sorry I can't offer any legal advice but may be worth contacting the pediatrician associations and accrediting boards for further info and / or to put in a complaint. I'd like to know who this doctor & practice is so I never use them.

Also, if your son still needs medical help you may want to try the CVS Minute Clinic. We have great insurance but I've still used them for some things. You can view their services on line at www.minuteclinic.com.

I am not sure...but I would at least talk to a lawyer...but you seeking another doctor is good...find out if they have simular policies...you can also take this to the newpapers...I did that once it felt good to voice what happen to me and it helped others who had the same thing happen to them...and that help my doctor see how his staff was treating the patients. Make a story short...power got to head nurse who ran office and she is no longer there.

You should contact your insurance company and find out what's going on. I've had different issues, with my kids having primary and secondary insurance, and payments not being made that should be, and though the primary carrier won't talk to me since I am not the policy holder, I talk with my insurance company and they typically take care of it.

Hey M.,
I wouldn't waste anymore time with this doctor's office. Find yourself a new one! I'm sure they have a right to refuse to see you if you don't have insurance, unfortunately. Different offices have different policy's.
I would join a yahoo meetup momma group in your area and ask around to find a new ped. And when you do, be sure to ask if they would refuse to see you if you were having some snafu with your insurance. I hope that helps!
blessings,
J.

I would change doctors! the heck with that. sometimes the people in the front office are just so rude that it is not worth dealing with. kids adjust quickly, so I would see who else is in your medical network.