mgriffiths Posted June 13, 2018 Share Posted June 13, 2018 I have a patient that I ordered an MRI of her neck (approved by insurance) and for some reason the hospital completed an MRI of her shoulder - and didn't do the MRI of her neck. Since the MRI of her shoulder was not approved (and wasn't needed) the insurance company isn't paying for it so the hospital has decided to just straight bill the patient for thousands of dollars of inappropriate charges. Anybody have some direction to where I can attack the hospital to get this wiped due to the radiologist's stupidity? Link to comment Share on other sites More sharing options...
camoman1234 Posted June 13, 2018 Share Posted June 13, 2018 10 minutes ago, mgriffiths said: I have a patient that I ordered an MRI of her neck (approved by insurance) and for some reason the hospital completed an MRI of her shoulder - and didn't do the MRI of her neck. Since the MRI of her shoulder was not approved (and wasn't needed) the insurance company isn't paying for it so the hospital has decided to just straight bill the patient for thousands of dollars of inappropriate charges. Anybody have some direction to where I can attack the hospital to get this wiped due to the radiologist's stupidity? HR/Billing department. You can climb the ladder really quick by saying the "F" word.....Fraud Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 14, 2018 Moderator Share Posted June 14, 2018 take to the MRI department head and demand to know why they performed and exam with out a providers order yep that is illegal they should in fact report this to the state as an event.... then tell the patient that if they do not remove the charges immediately that they should contact the local paper and have them write a story on it.... Link to comment Share on other sites More sharing options...
CAAdmission Posted June 14, 2018 Share Posted June 14, 2018 They were probably just getting a baseline study, in case she ever injures her shoulder. Link to comment Share on other sites More sharing options...
mgriffiths Posted June 14, 2018 Author Share Posted June 14, 2018 thanks for the input, I talked with their billing department and was told patient would have to pay if I didn't do a "retroactive PA." I wasn't willing to do it since that would be fraud on my part as she definitely did not need a shoulder MRI. I have since spoken with the radiologist personally who performed the procedure and after a lot of backtracking agreed to "deal with it" as it was not the ordered procedure. I'll call next week to confirm it is taken care of. Link to comment Share on other sites More sharing options...
entpac Posted June 15, 2018 Share Posted June 15, 2018 My hospital would have absorbed the cost. No question about it. I sincerely hope this gets rectified for your patient. This likely caused a great deal of stress for the patient involved and an apology from the group making the error is appropriate. I agree that it would be illegal to charge the patient for performing a test that was not ordered. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 15, 2018 Moderator Share Posted June 15, 2018 quick call to your state insurance commissioner by the patient will likely get it resolved in rapid fashion..... Link to comment Share on other sites More sharing options...
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