Re: Reporting ERRORS-Checking for ERRORS

[Guest guest]

ALL,

The Patient Advocate will usually refer you to their " billing " department and

they do usually have to file a report. The quality assurance

officer/representative HAVE to file reports and have to have it resolved or

status reported that. Write a memo, with bullet statements, i.e. Issue :

Charged for Demerol 250 mg 600.00 given 5/12/1011, this is impossible, I am

allergic to this/

See attached hospital bill, documentation of allergies.

I have had to do this when I had a reaction to a medication because the Nurse

placed the nurse incorrectly and it infiltrated all into my tissues and I had

red splotches all of my arm. She tried to tell me that it was not infiltrated

because she got blood return, and it was the blood that was dried in outside the

injection site. I told her either you take it out or I will and I know how and I

am the one with the swollen hand and going to be arm if you wait.

They had bandaged around my IV site so they couldn't see it. Two months ago, I

was in ICU and no coherent and they were going to put a catheter in and I said

NO, and was fighting, well this nurse had my husband lie down on one of my legs

so I wouldn't move and got another man (male nurse, I assume) and I was fighting

as I felt I was being raped they were holding me down so hard.

They put the catheter in wrong at an angle and I told them please adjust this it

hurts and I was trying to take it out. It has been two months and I still have a

raw area where she stuck the catheter and all she had to do was deflate it some

to straighten it out.

I also am surprised that deductible years are not always calendar years so make

sure of that. I am like you also and I call the billing company and tell them

that my bill is incorrect and that it will not be paid until the hospital

straightens the charges out.

I encourage everyone to always go over your Doctor bills and Hospital pills. It

irks me that you are charged for a whole vial of a medication when you get a

dosage out of it and then another person gets a dosage out of it, you are

charged for a whole roll of tape, a whole package of gauze whether you use it or

not.

I assure you if you call the quality assurance representative OR the

administrator, always tell them it is a personal issue that happened that you

need to speak to them directly, and don't give us and there will be something

done. Most clinics and hospitals use billing companies now and they do not do

anything EVEN getting your insurance but make you provide it even though you

have provided it four times at the hospital (my pet peeve).

* I audited medical contracts as a Military Medical Services Officer and I can

tell you, one mistake can get in a computer system (code) and stay in there

forever. Their can be untrained young people used to do work they should be

trained not know how to evaluate records and one civilian oxygen contractor (to

rename nameless) ddid not have their respiratory therapists check on clients

monthly (as referenced in their contract) and the driver dropped off the oxygen

tanks.

Now this was an acceptable change within their company but was still current in

the contract with the military hospital I was assigned. I found THREE MILLION

DOLLARS in over charges, this company taking money from Medicare /Insurance ,

when the Hospital was paying for it through Tricare and their oxygen clinic,

they did not keep up with clients who had passed away, prescription for oxygen

had been discontinued-THREE MILLION. I created a checklist to put in the front

of each contract the military hospital had so they could check the charts of

each contract.

It was comical as I was assigned this project as a Reservist and the base

contracting (which medical contracting go thru also) the companies I contacted

(I went straight to the Insurance person and most project officers assigned this

are not Nurses and know to do this, and I know how to pump for information " I

am calling to update records " ) Everyone wanted to know who that Major was

and where did she come from.

I audited one Doctors patients' file and he was charging every visit an extended

visit. Well, an extended visit requires vitals have to be taken and a health

provider has to do hands on. It can't be stitches removed, a follow up, are you

okay, fine, bye. Well, this audit found that the computer program they were

using gave EVERYONE an extended visit of 200.00 rather than limited visit of

60.00

I audited a pharmaceutical contract we had, and when we don't have generic

available we order brand, it has to be changed in computer, then if the

technician does not change it back,the system continues to charge the hospital

for brand medication when generic are being received, A daily report is always

turned into the company and there is a company liaison for the military for this

system. My boss had me auditing all the medications we could change over to

generic without a problem. This is how I found this above error and was talking

to a young airman.

Her reply was, it's only five hundred dollars a day. I said okay, lets look at

that, multiply five hundred times thirty and now look at all the medications I

have highlighted and if it is over a hundred, what is that. She looked

surprised. I then answered and what is so bad is that you make a report daily

and all you have to do is check with our distributor (Bergen, who I had worked

for) and they can reimburse this money and change the codes back to generic. I

then told her that did she like the taxes taken out of her check, No was her

answer. Well, these taxes pay for your mistakes so this is

YOUR money.

I also am always surprised when my insurance has a memo with doctors I see that

they will accept the acceptable charges and the member should not pay more. EVEN

if a Doctor tries to tell you to sign a paper you are responsible for the

difference BUT YOU ARE NOT, there is a federal fine for Tricare Doctors if they

try to collect more than the allowable charges.

The large charge you see they charge is computer generated and they use this

information at the end of year to write off what they were paid and what they

could have paid.

I NEVER sign the form that says that other procedures might have to be done and

if my insurance does not pay, I am not responsible. I state, " I do not agree and

if my insurance does not pay,

don't use it " I had a surgeon have me sign one of those and after my surgery, I

got a two hundred fifty dollar charge for a surgical technician, just a RN. I

called the hospital and stated, Don't you have surgical technicians that can

assist my surgeon and they said yes. I told them, then you need to subtract that

out of the surgical fee you charged me and it should be posted this Doctor uses

his own surgical tech and you will get a charge and give people a choice but

this is double charging. I spoke to Head of Surgery and told him and they were

going to vote on this and I told my Doctors

office.

Did not mean to write a book, but if you don't examine your bill, know your

insurance has a Medical Case Manager you can call, learn to. You might be paying

for things you did not get and

overcharged. My brother in laws Father who had diabetes was charged with

amputation of his leg and it was the wrong leg. My Mother had gall bladder

surgery and they charged her for cast.

They NOW write in Black Marker, THIS ONE, to prevent Surgeons cutting wrong

place. I have written on one of my multiple scar revision on my breasts " LAST

TRY< GET IT RIGHT "

My Doctor had sense of humor but it was permanent marker I worry about those

that do not know how to check their bill and pay them anyway. Bennie

> Moderator's Note: For future experiments try asking for the Patient Advocate

or Supervising Floor Doctor.