Who Is Responsible?

[Daffodill1]

If this needs to go into another thread, then please go ahead and put it there, I think it should be a new one, but not sure.
OK, here goes.
As you know my TKR was done in July of last year, and PT did an MUA without the A (anesthesia) in Sept. Prior to that, I was progressing normally I believe, after reading everyones progress during their first 8 weeks. Even tho I was going thru hell, I think that is just the way it is. However, after the PT episode, everything went downhill really really fast. Even OS said that the cause of my predicament was probably due to the PT.
So, when the Doctor went in to do the arthroscope to find out what was going on in there, he found a lot of scar tissue that had started to form in the beginning, but was torn during the PT episode, so he removed it.
For the first few weeks after the PT episode I wasn't charged for xrays, but after about 4 months, and no improvement after the PT episode, I started getting EOB's (explanation of benefits), and there they were, several xrays, office visits, etc. THEN after the arthroscope, I am now getting bills for the operation! So now I am paying for the first arthrscope, not a problem, tkr, not a problem, but I am also paying for the exrays and office visits prior to the 3rd surgery, which was removal of scar tissue. BTW, OS said he had run out of things to try with me and the only thing he knew to do was go in and take a look.
My question is this: Since problems started after the PT episode, and OS admitted that it was probable that the episode started this, then should I be the one to pay for all of that?
And now, I am going for a second opinion this morning to a NEW doctor, don't know what they will find or how they will find it, but what about all of those bills? And, OMG, what if I have to have another surgery???? What about that bill?
How do they determine who or what is actually to blame for all of this pain?
I know no one here is a lawyer that I know of, I just want to see what other's thoughts are on this.. right now money is not growing on this particular tree...

any advice???

 

[Dewy]

Margaretd,

It might be useful if you clarified a few things:

1/ Was the physio employed by the surgeon or was he/she a freelancer?

2/ Did the surgeon or anyone else imply or suggest that the physio was actually negligent or incompetent or anything like that?

3/ This is not strictly relevant, but are you having to pay all these bills yourself or do you have any insurance? (In the UK, we are so lucky, as it is all free here.)

 

[cotton1958]

Pretty sure you are responsible, and you probably have signed off on paperwork saying you are. You of course can take your claim to an attorney and get free advice, but it's very expensive for a lawyer to try a malpractice case, and it would have to be worth a whole lot for them to want to do anything for you. Newer laws in many states, protect healthcare workers.

I know even with insurance, your/our bills are high, but be glad you have it.

Hopefully, I may be wrong for your situation, but have gone through it myself and it's not a very nice story.

 

[BigGene]

The simplist of answers is that not every case proceeds in the same way and there are no guarantees of how we progress or even if we will get better.

That said if "mistakes" were made then liability might exist. I would note that an unsatisfactory result is not automatically considered a mistake.

Assessing liability is a long and arduous process. It always involves lawyers. No one is likely to waive fees or pay for procedures without a determination of a legal "mistake".

This process will always require a doctor who is prepared to testify to a "mistake". (know as a breach of the standard of care)

If all this sounds complicated, it is. Your first step, when you feel you need to proceed down this path is to consult a lawyer who takes medical malpractice cases. Interestingly, choosing a lawyer is much like choosing a doctor, it is very important and you want an expert.

Gernerally, in a malpractice case there are no up front fees paid by you to the lawyer.

It's your call when you begin that process. Generally you have a fairly lengthy period of time to get a lawyer and begin the process. Usually more time than is needed to take care of your health first.

Lawyers and malpractice cases take a lot of energy and generate much stress.

In my opinion, please focus first on getting better and getting the best doctors possible to help you do that. If that means 2nd or 3rd opinions do it.

That is my experience and opinion, for what it is worth.

I'm am sure others will weigh in as well.

 

[PhoenixS]

Most insurances cover what would be called a "global fee". This fee covers the main surgery and post op period (usually 1 or 2 post op visits).
If the office staff codes a different diagnosis code, the insurance usually picks it up. If they use the same code, then usually the physician needs to eat the extra work. I'm not sure that they can legally 'balance bill the patient' (make you pay the fees not covered by your insurer)
You might ask for an itemized statement for AL your visits, PT Surgery and Post op stuff, with the codes and how they have been billed by the billing department. Take that and have your insurer look at it.
A lot of Docs can "bill creatively" which is not against the law per se, but usually government funded insurances (like medicare) wil not pay.

I am not a lawyer, but have taken some coding courses. Definately get a dialogue going with your insurer.
Hope this helps
Sandy

 

[Daffodill1]

Margaretd,

It might be useful if you clarified a few things:

1/ Was the physio employed by the surgeon or was he/she a freelancer?

2/ Did the surgeon or anyone else imply or suggest that the physio was actually negligent or incompetent or anything like that?

3/ This is not strictly relevant, but are you having to pay all these bills yourself or do you have any insurance? (In the UK, we are so lucky, as it is all free here.)

Yes, PT is employed by the group of doctors.
Yes, my OS did say that the PT should not have done what he did, and he understood why I was in the pain I was in shortly afterward, which continued.
I am on short term insurance, the first arthroscope and TKR was on that insurance, so by the time the TKR happened all of the costs were covered.
When I went on to the next insurance, I had to start all over with my deductible, so from Oct until now, everything is coming out of my pocket because I have not met my deductible.
That is the reason I asked about all of this. I would not have had to go thru numerous office visits, new exrays, a 3rd surgery, now a second opinion if the PT had not done what he did. I know that there is no way to know for certain, but heck, I do know that the pain all started when the PT episode happened.
So I owe all of this money for something that probably is the reason for the last 8 months!
:hissyfit:

 

[Truivia]

Hi - I have read some of your posts before but we don't know each other yet :biggrin:

My first thought is this - does it say any where in your medical records that your OS puts the "blame" on to the PT actions/treatments?

If it is not in writing, then it usually does not count/matter :rolleyespink:

 

[maryo52]

I was always taught that three things had to be proven to establish legal responsibility for a medical error (but I'm no lawyer!)

One, that a mistake was made;
Two, that harm was done;
and Three, that the harm was caused by the mistake.

As far as billing, each surgery I've had has included three months of "global care" afterward. I saw the ortho last week and it was covered under my 2/23/11 procedure.

Sorry I can't be more help, Margaret.

 

[DebR]

Margaretd, Hi, manage a surgical office and have done billing in the past. Mary is right, you are covered for 90 days for all post-op care after a TKR. Should include office visits, x-rays done at those visits to check the TKR. After that 90 day period is over you are responsible for any co-pays, etc for additional visits. You began a new insurance so yes, you are responsible for the deductible. Once that is met, depending on your plan you should only have to pay the co-pays. Since there has been no legal action or decision, you will continue to be billed for all services. The doctor can charge for the surgery etc because he is probably using a different diagnosis. If you have adhesions, swelling, pain whatever he is able to charge for these services. The only other course of action you can take is to speak to an attorney and decide if you want to pursue this further. Please know, this can take years. If you feel you were being charged or billed for routine post operative care, contact your insurance company and ask them to look into this. I totally understand that you do not feel this is fair, and I know how fast the expenses add up My new knee cost me almost $2000 in deductibles! It is frustrating as hell, but until guilt on someone's part is proven, legally, the physician and hospital may bill the insurance company.

 

[kneesrus]

The first thing that needs to be done is, was the PT performing a procedure that is discribed in the Practice Act for PT and was the PT properly trained.

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·​

Clinical programs in entry level education - Marymount University in Northern Virginia has
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Hope this helps,
David