Consumer Law, Warranties contract

[Missy2]

I am being sued for medical bills soon to be expired.
At the time, I had insurance but could not afford the extra expenses. I was well below poverty level for income guidelines.
The expenses occured as part of an emergency cardiac problem.
I signed a brief promise to pay, with no balance, etc.,.
I signed under duress, as the hospital would not admit me unless it was signed. The cardiologist said I would not have lasted another hour had not I got in when I did.
The Hospital failed to supply Itemized bills until recently so I stopped any payments.
I was told by an attorney that I qualified under Some Federal Law that my state adopted, stating that a hospital could not refuse treatment for medical necessity and once admitted could not release me until stable. I need to find the Federal law this
falls under. I need this information for my defense the Judge stated I must find this particular code.

Thanks for any help you can give me.

 

[Michael Wechsler]

Is your defense that you shouldn't pay anything at all because you signed these hospital forms under "duress?" What do you mean medical bills "soon to be expired?"

 

[Missy2]

Defense

The medical bill is almost 5 years old. Statutes of Limitations.
The hospital recieved reimbursement from my insurance carry. I told them when I came in the ER I could not pay much if anything other than what the carrier would pay.

However, I continued to pay small amounts for almost two years and never recieved a Itemized statement for the charges from the hospital after repeated written notices to them.

The hospital full well knew I could not pay when it accepted me.
I gave them copies of finacial statements. They were to
file the rest of the bill under sometype of Charitable thing.
They falled to do so and waited to long to collect their funds
from the Government. After that they continued to hound me for
funds that they could not get otherwise. Almost 5 years later
Court for a very large sum of money. ( In court I finally recieved the Itemized statements.)

I would have died had I not gotten some form of treatment.
I was covered under the federal law that protects persons in emergency situations from being turned away from hospitals for medically necessary treatment because of, creditworthiness or ability to pay the bill.


The code is what I am looking for, I was told that it fell under one of the many "Good Samaritan Laws", or possibly "anti-dumping"
Laws.


Thank you for your response

 

[Michael Wechsler]

A couple of things. First, my understanding is that the statute of limitations deals with bringing actions, which it seems were brought before the statute of limitations expired. It does not mean that there is a limit on when an issue can be discussed. The case does not come to a halt 5 years from the day of the bill -- they have 5 years to bring the case. Perhaps there is something else I am unaware of, I can't be sure, but it seems that they have commenced action in time to litigate the issue.

Next, I don't know offhand a law you are talking about but you should separate issues and make sure your thinking is consistent. (1) Whether they refused you medical treatment because of your financial condition. (2) Whether a hospital that knows that a patient cannot currently pay the bill can pursue that patient for the bill after treatment.

A law that says that they cannot refuse you medical attention based upon your income level doesn't necessarily mean that if you say you can't pay then you are completely absolved of any liability -- unless the law says so explicitly, of course. I would wonder if this is the case since most would plead poverty on the way into the hospital and then, after treatment, claim that they don't owe the money because the hospital knew the score from the beginning. So it seems that they didn't turn you away from receiving treatment -- but does this mean they cannot pursue you for the bill? Does it mean that their only recourse is to seek reimbursement from a charity and that they could never go after you? What if you won the lottery? I don't know the specific answer here but I think you need a protection in addition to the refusal of treatment issue because that seems not to be an issue, although I could not be sure of course.

 

[Missy2]

Dear Michael,
You are correct I need to get everything together.
I did find the law I was needing is is Federal law under the Social Security Act. 1968,1988 and current. Various sections apply but main 1396 of 42 USC. It has been adopt in 49 states.

In brief, a person doesn't have to participate in any XIX or XVII to qualifiy. But the original intent is for anyone of any financial means, that has an medical emergency to recieve basic normal treatment. They must stabalize a patient and offer post stabalized care. And not be turned away from the hosptial because of any finiancial situation or discrimination.

The hopitals are reimbursed through state funds, given to them from the Federal Government.

Any person with a medical emergency gualifies. The hospitals must be acute care settings, and registered to profide services.

I fell under the lines of a " medically necessary emergency" and
was treated.

If I had no money or a lot of money the service is still free regardless. Its the law, only hospitals that are private an not
registered to recieve medicaid and medicare are expempt.
Non-emergency claims are exempt under the law.

I had insurance, but could not afford the deductables or copays.
I could really afford the insurance!!
I waited hours before going to the ER, the doctor said I waited almost to late. I waited because I couldn't afford the added expenses... and made my self very clear on this matter.

Again, the hospital under the law, could, or did, get reimbursed for my service. Plus my insurance carrier paid, plus I paid.


For a service that under the law was free to me because of the circumstances.

If you read the code you will see what I am saying.

Anyway this hospital is a supposed be non for profit charity hospital. As regard to your asking about proof of Income.
I did supply Tax records for this reason.

But regardless of the situation...If the Federal and State laws say
anyone entering a hospital in desperate need or is in labor, they must be seen, treated and the hospital is reimbursed.

The hospital took thousands of my insurance carriers money and mine, and still try to collect the rest?

That is the jest of the story...

There are several case laws pertaining to this issue.

 

[Michael Wechsler]

I looked at some of the code for 42 USC 1396 but didn't find the other two... here is Section 1396:

Sec. 1396. Appropriations
For the purpose of enabling each State, as far as practicable under the conditions in such State, to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services, and (2) rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care, there is hereby authorized to be appropriated for each fiscal year a sum sufficient to carry out the purposes of this subchapter. The sums made available under this section shall be used for making payments to States which have submitted, and had approved by the Secretary, State plans for medical assistance.

This seems to be a fund to assist and empowers the State to allocate money to it.

In brief, a person doesn't have to participate in any XIX or XVII to qualifiy. But the original intent is for anyone of any financial means, that has an medical emergency to recieve basic normal treatment. They must stabalize a patient and offer post stabalized care. And not be turned away from the hosptial because of any finiancial situation or discrimination. The hopitals are reimbursed through state funds, given to them from the Federal Government.......If I had no money or a lot of money the service is still free regardless. Its the law, only hospitals that are private an not registered to recieve medicaid and medicare are expempt.

Are you sure? From what you wrote I would think that everyone's medical emergencies are therefore paid by the government under this Act and that doesn't make sense to me. There might be something about harassing the indigent. The above code seems to imply that the state sets up a fund as is practicable and the fund tries to assist in these matters but I don't see what happens if the state doesn't pay the entire bill. Did the hospital ever claim that it was paid -- even partially -- from the government?

 

[Missy2]

Well, I am not sure which to answer first. I am sorry about my last post. I have spent lots of hours with little sleep preparing for todays court date. I don't mean that everyone is obsolved from any payment. It is not Free for everyone.
At the time, my income was very low. $15,000 for a family of 4.
The bill was nearly half that yearly amount for One night in the hospital. If I had not used my insurance card to get treated.
I would not have been treated. They should have filed to any all charitable causes at their access under the circumstances. After all they are supposed to be a non-for-profit hospital.

I live in an area where we have only one open hospital and one closed hospital. Another hospital was almost 45 minutes away.

The code is 42 USC 1867. I am sorry for the error. I believe 1396 is were the federal government allocates so much money to each year for the purpose it states and this funding is what the states are paid out of for those type of assistance programs including expenses from 1867. At the State level how it is dispenced or the catorgories used for payments are unknown to me.

Anyway, no, the hospital was not reimbursed. They stated that because I continued to pay the bill, they did not file.
And it is to late for them to file now. I stated to them that they should have filed anyway and reimbursed the state fund for any over charges. They say I was responsible from the start.
The Judge did ask if they knew about the law (1867)and they said yes, but they never had anyone use it. I said that is because you do what you do to me, you just take them to court!
The Judge said she had never heard of the law an it was just something I found and was trying to run with.
I tried to give all pertant material but she just said itwas
about not refusing treatment.

I can not make the 3 Judges I have been before to understand the correlation of this Law to my problem. This was not just the typical medical type bills.

It is not my responsibility to make sure the hospital files it's bills timely to get reimbursed. The Judge said it was my responsibilty
to make sure that it was.

During the time that this occured, I continued to pay because I was told that I didn't qualify for a reduction in the bill by the hospital, because of my wages. Now they say they didn't file because I didn't provide the tax information.

I can not see a policy that mandates such an expense to a hospital and puts them at risk for high loss, then not provide funds for it's support.

From what I have read, I believe that if the patient can pay the amount in whole, the hospital could not recoupe funds for the treatment because they are being fully reimbursed by the patient. If a patient could only pay partial then they would only file to recieve the difference. And for patients that can't afford anything I would feel certain that the hospital has means to file to collect the total loss.

The other issue I am contesting is the contract or lack of.

The hospitals policy is that you must sign a sheet accepting responsibilty for payment in order to be treated in the Emergency Room. If you don't sign you don't get in.

Contradicting the terms of the Federal code.

They admitted in court today that they will not see you other wise. (But since they are the Plaintiff the Judge did not
make them explain much of anything. And she certainly didn't make them answer any of my questions!)

If a patient must be treated...and you don't sign.... they are in violation of Federal and State Law for not accepting you.
And if you sign just to get in and you are telling them this is the only reason because you surly can't pay it. (I did this verbally and in writing.) Then it would seem to me there are no terms of a contract.?. And still then, does it meet the elements required of a contract? And if is a contract is it an enforceable one?

Obviously, my defense is no.

Michael, I really appreciate you reading my long posts and as you can obviously tell, I have no legel experience. And the issues you have raised will help me clearify myself better for my next court date, I hope. If not I will just give up trying to fight it.

In my mind I think I know what I am trying to convey, but it doesn't usually come out that way.

 

[Michael Wechsler]

Originally posted by Missy2:
The code is 42 USC 1867. I am sorry for the error. I believe 1396 is were the federal government allocates so much money to each year for the purpose it states and this funding is what the states are paid out of for those type of assistance programs including expenses from 1867. At the State level how it is dispenced or the catorgories used for payments are unknown to me....They say I was responsible from the start.
The Judge did ask if they knew about the law (1867)and they said yes, but they never had anyone use it. I said that is because you do what you do to me, you just take them to court!
The Judge said she had never heard of the law an it was just something I found and was trying to run with....Michael, I really appreciate you reading my long posts and as you can obviously tell, I have no legel experience. And the issues you have raised will help me clearify myself better for my next court date, I hope. If not I will just give up trying to fight it.

In my mind I think I know what I am trying to convey, but it doesn't usually come out that way.

I'm sympathetic to your plight and can only give you what I think is common sense for court, and that is to know exactly what the main question is and your answer before you get to court. Here is what I think it is, IMHO:

Issue: Does a hospital bear the burden of filing for reimbursement from alternate sources in the event that medical screening of the patient reveals that the patient is indigent?

You have to find the answer. I looked at 1867 and cannot say that I disagree with the judge. It doesn't answer this question and merely defines the process of medical screening requirements. You need to show that the burden of filing was on the hospital to file. IMHO and limited knowledge of the facts, that may be the critical factor to winning your case.

 

[Missy2]

Michael my case was settled

Dear Michael I thought I would update you on the outcome of my case I did not win, but I did prevail in many ways.

I came in front of my 5th and Final Judge. He was very fair and non condensing. I was not verbally scolded with this one.

He did award them judgement, but only partially and dismissed their protest for past interest.

After Judgement he also stated that I might have other legal recourse in federal court regarding the other elements of my case. But would have to seek the advice of a counsel on those issues.

He guestioned in a life and death situation if a non profit, community hospital could force a patient to sign a contract and make it a stipulation to recieving emergency care. The hospital did state that if I had not signed they would have refused treatment.

The Judge asked the lawyer to explain why his client would refuse treatment to someone who would die if not treated?

The lawyer sayed we didn't refuse treatment.

The Judge said but your client just stated had the contract not been signed the patient would have been refused treatment.

He said he questioned the legality of that kind of action.

It seemed to him this particular kind of case was what the law
was pertaining to.

He felt under law a contract signed under these circumstances was questionable.

They asked at what time should they have the patient sign the contract. He said he could tell them but if it is a life and death situation he doubted the patient would be able to leave the hospital, so anytime after the patient had stableized would seem more reasonable to him. But he doubted it could be used for the sole reason for denial of treatment.

He felt it negligent on my part not to make certain the hospital filed the proper paperwork to be reimbursed. But also stated that I could not force the hospital to file for reimbursement.

The settlement amount was figured at what the hospital estimated it would have recieved if the proper paperwork had been filed, what they actually recieved from me and my insurance.
and the difference was what they were awarded.

In any case the Judgement was set at an amount that I can pay off hopefully within the year.

So I am happy with the outcome and they didn't look so smug this time around.

Thanks Missy