Hospital misled us into taking services for MRI that they then said they don't do

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illumna

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I'm not sure where this would be filed as I don't think it technically falls under medical malpractice but ultimately I'm posting to ask what to do next and what kind of lawyer we would possibly need down the road.

Here is the situation: I took my wife into a walk-in clinic for an x-ray because at home she was running and fell on her shoulder. The walk-in clinic took x-rays, gave her pain meds, and a sling and stated that there is no brake/fracture and recommended an MRI to determine if she has a torn ligament to which they stated we would need to go to the hospital's ER (not affiliated w/ walk-in clinic) to get an MRI. I questioned this and asked why we can't just schedule this for another day instead of getting charged ER fees. Their concern is that because my wife had numbness in her arm we should rule it out as quickly as possible.

We go to hospital's ER. At the front desk my wife told the registering nurses the situation: She had a fall, had an x-ray, was rendered care, and sent there for MRI. They told her to check in. Upon checking in, she told two "clerks" the same thing: we are here for MRI. She was sent to a minor injury room. A male nurse (Steve) came in told her to take off her shirt: My wife asked why? He stated for an MRI. A new nurse came in (Roberta) stating they would take her to x-ray.

I questioned this stating that we already had an x-ray from services rendered at walk-in clinic. She stated that before we can have an MRI they need an x-ray and they do not accept x-rays from external resources. She gets x-ray because of course this is the policy they laid out for us. Dr. comes in tells us what we already know that there is no break but then says they do not do MRIs there that we would have to schedule.

We made a complaint to the head RN stating that if we would've known this we would have made the appointment and felt like we were misled into receiving services we did not need or want and that they had plenty of opportunity in their process to state that they did not do an MRI and they should've referred us to this earlier. She made excuses stating that it is their policy that nurses do not recommend scheduling MRI's that it is their doctor that does this and that they rarely do MRI's and only in cases of stroke. Also, we find out from her that they do in fact receive X-rays externally if they are sent in the form of a disk. During four hour wait we could've had the walk-in clinic send this disk.

My concern is not with the walk-in clinic because they may have not known hospital procedures but the hospital (ER) itself knew that they do not do MRI's but they let us go through the process anyway, and again, the many staff members (even a nurse) told us that in order to have an MRI they need an x-ray.

My first step is to call my insurance company and make a complaint to them. Then, the head RN gave us a hospital complaint number. Any suggestions?
 
Nothing to see here, nothing to complain about, except you are unhappy.

The hospital had no way of knowing her arm wasn't broken.

Practicing good medicine and caution, the arm was examined and an
X-ray taken. Physician read X-ray, arm not broken.

Your wife needs to contact her primary care giver.

If she doesn't have one, that's why it appears you're getting the runaround.

That's why medical protocol suggests we all have a family physician who works with the patient to avoid scenarios similar to yours.

Good luck, and I hope your spouse is healing well.
 
Nothing to see here, nothing to complain about, except you we're unhappy.

The hospital had no way of knowing her arm wasn't broken.

Practicing good medicine and caution, the arm was examined and an
X-ray taken. Physician read X-ray, arm not broken.

Your wife needs to contact her primary care giver.

If she doesn't have one, that's why it appears you're getting the runaround.

That's why medical protocol suggests we all have a family physician who works with the patient to avoid scenarios similar to yours.

Good luck, and I hope your spouse is healing well.

I would concede your point but having a hard time with the fact that we did not go to the ER for ER care but instead went there asking for an MRI. If my wife fell and asked for a mammogram instead wouldn't they have told her that they don't do mammograms in the ER? Likewise, we already had x-rays, they wouldn't receive them. In our situation , it is the same if I was sent to a mechanic for transmission work and upon arriving told them I wanted them to look at my transmission and they said we we won't look at it until we do x, y, z diagnostics but after doing x, y, z they state, "We don't do transmission work" but we'll charge you anyway. What is the difference?
 
I would concede your point but having a hard time with the fact that we did not go to the ER for ER care but instead went there asking for an MRI. If my wife fell and asked for a mammogram instead wouldn't they have told her that they don't do mammograms in the ER? Likewise, we already had x-rays, they wouldn't receive them. In our situation , it is the same if I was sent to a mechanic for transmission work and upon arriving told them I wanted them to look at my transmission and they said we we won't look at it until we do x, y, z diagnostics but after doing x, y, z they state, "We don't do transmission work" but we'll charge you anyway. What is the difference?


I'm not the person you need to convince you're right.
If you find my comments to be useless, ignore them and me.
 
You likewise.


That won't work, mate.
As an admin, (and contributor) I interact with everyone.
The message here is, follow our rules.

My admonition stands, ignore my advice.
I'm not the one you must convince.
Arguing with me is a waste of your time.
Even if you changed my mind, you still would be without the result you seek.
There's great logic in that, mate.
 
I would concede your point but having a hard time with the fact that we did not go to the ER for ER care but instead went there asking for an MRI. If my wife fell and asked for a mammogram instead wouldn't they have told her that they don't do mammograms in the ER? Likewise, we already had x-rays, they wouldn't receive them. In our situation , it is the same if I was sent to a mechanic for transmission work and upon arriving told them I wanted them to look at my transmission and they said we we won't look at it until we do x, y, z diagnostics but after doing x, y, z they state, "We don't do transmission work" but we'll charge you anyway. What is the difference?

Why didn't you just ask them about that when you got there? I've had a lot of experience with hospitals in the last three years. I already would have known that you have to schedule a MRI. The nurse at the walk in clinic RECOMMENDED a MRI. That's just a recommendation. You didn't have to go get a MRI.

Hospitals don't take outside x-rays really anywhere unless it is sent from the other hospital or clinic. I've had to take my daughter to the ER to get her central line fixed and she still needed her infusion. I had the medicine primed and ready - they couldn't use it. I had to always sit and wait for their pharmacy because they couldn't use outside medicine and it was a blood medicine they would have had to have it checked. Pain in the butt? Yes. But policy.

You can complain to the hospital. That's why they have a department or person who handles complaints. Not sure what complaining to your insurance company will do.

It's not the same as going to a mechanic at all. But your little comparison happens when you go the mechanic. My power steering went out when I tried to help someone jump start their car. I took it to the dealership and said it's probably just a fuse that went out. My brother is a mechanic he said that's probably what it was. But I couldn't drive it for a week until he could come look at it. The dealership said they have to run the diagnostic tool on it to make sure it's not something else. So I had to spend 179 when it was nothing more than a $8 fuse that went out. And the guy gave me his number to repay me if I had to take it in - yeah I never got repaid.

That's how things work. Sorry you don't like it. Yeah hospitals charge way too much for things. But no one made you go to the ER. A clinic nurse making a recommendation isn't an order. You chose to go to the ER.
 
Leslie,

Why didn't we ask them that when we got there? We did ask them when we got there and that's my issue and you'll see below that we have more info from the referring clinic. We went for MRI services, not ER services. We notified them when we arrived. If we asked for a mammogram they would've turned us away. Why didn't they turn us away for the MRI when they know that they don't do them?

We have recently received more info from the walk-in clinic that sent us. The dr. and radiologist there did in fact call the orthopedic office at the hospital prior to sending us to the hospital and the ortho's office recommended that we go to the hospital for the MRI because my wife's arm was numb and they wanted to prevent nerve damage. The walk-in dr. called the hospital's ER comm staff notifying them that we were going to arrive for an MRI and that there were no broken bones--they want them to look at ligaments. The ER comm staff didn't tell the referring dr. that they do not do that service, instead they told them to send us over. Back to the above, we told everyone we met w/ why my wife was there and still they sent us through the ER gauntlet knowing that they do not do MRIs.

I spoke w/ my insurance company today and they stated that when the claim comes through that I can file an appeal and encouraged me to do so because records will show same day duplicate services. They said, we don't care about their policies, the hospital can't argue their way out of having charges of services already rendered. They said it's their problem that they did not communicate w/ the referring clinic to retrieve the x-ray. Where that will go I have no idea.

I also called the patient advocacy today at the hospital (the ER head nurse gave me the # yesterday) letting them know the issue and the person I spoke with will speak with their leadership team. I'm not sure where that will go but it's worth a try.
 
The x-ray was redone as you didn't have the disk with the one done at urgent care with you and it would be irresponsible to send a patient away from the ER once they arrived to go get one.

If it were truly an emergency situation the MRI would have been done right away, but that isn't known until after she has been examined. It would have been irresponsible to take your word for it that she was fine and just needed to schedule a MRI or to tell you it could wait without having examined her.

This is the opposite of malpractice.
 
My first step is to call my insurance company and make a complaint to them. Then, the head RN gave us a hospital complaint number. Any suggestions?
These are two avenues of complaint. Go ahead and use them.
 
The x-ray was redone as you didn't have the disk with the one done at urgent care with you and it would be irresponsible to send a patient away from the ER once they arrived to go get one.

If it were truly an emergency situation the MRI would have been done right away, but that isn't known until after she has been examined. It would have been irresponsible to take your word for it that she was fine and just needed to schedule a MRI or to tell you it could wait without having examined her.

This is the opposite of malpractice.

I agree it's not malpractice and I mentioned in my initial post I don't think it wasn't in the correct place but if you have a better forum I can put it in please advise.

My concern isn't malpractice and yes they shouldn't take my word for it but as I posted, my referring dr. had already discussed w/ the ER staff why were were coming over so shouldn't they take the referring dr.'s word for it?
 
My first step is to call my insurance company and make a complaint to them. Then, the head RN gave us a hospital complaint number. Any suggestions?
These are two avenues of complaint. Go ahead and use them.
I did and wrote above about it thank you.
 
The referring doctor doesn't do MRIs. The ER doctor should have been the one to assess whether it warranted an emergency MRI or if it could wait. The referring doc sounds like he thought it should be done urgently so it makes sense for the ER to determine whether or not that is the case.
 
Leslie,

Why didn't we ask them that when we got there? We did ask them when we got there and that's my issue and you'll see below that we have more info from the referring clinic. We went for MRI services, not ER services. We notified them when we arrived. If we asked for a mammogram they would've turned us away. Why didn't they turn us away for the MRI when they know that they don't do them?

We have recently received more info from the walk-in clinic that sent us. The dr. and radiologist there did in fact call the orthopedic office at the hospital prior to sending us to the hospital and the ortho's office recommended that we go to the hospital for the MRI because my wife's arm was numb and they wanted to prevent nerve damage. The walk-in dr. called the hospital's ER comm staff notifying them that we were going to arrive for an MRI and that there were no broken bones--they want them to look at ligaments. The ER comm staff didn't tell the referring dr. that they do not do that service, instead they told them to send us over. Back to the above, we told everyone we met w/ why my wife was there and still they sent us through the ER gauntlet knowing that they do not do MRIs.

I spoke w/ my insurance company today and they stated that when the claim comes through that I can file an appeal and encouraged me to do so because records will show same day duplicate services. They said, we don't care about their policies, the hospital can't argue their way out of having charges of services already rendered. They said it's their problem that they did not communicate w/ the referring clinic to retrieve the x-ray. Where that will go I have no idea.

I also called the patient advocacy today at the hospital (the ER head nurse gave me the # yesterday) letting them know the issue and the person I spoke with will speak with their leadership team. I'm not sure where that will go but it's worth a try.

Ok so that's about all you can do so what's the problem? You're not going to get charged. You called their advocacy line.
 
Ok so that's about all you can do so what's the problem? You're not going to get charged. You called their advocacy line.

Just because I call patient advocacy doesn't mean I'm not going to get charged. You asked "what's my problem?". Well, as I asked in my first post would be for suggestions. My expectation in asking for suggestions in an already lengthy first post was essentially stating the situation then asking, I'm going to do x, y, z, are there any suggestions after that or for that process? Sorry I wasn't specific enough but I was trying to explain what I've done, what I have left to do, and if anyone has been through this type of thing what I could plan for or ideas to do. E.g., Other helpful people I know recommended getting the hospital's bill of rights and looking through that. Other people I have spoke w/ suggested making notes of my process--names, titles, etc. So, I don't have a problem, I have a question. Thanks.
 
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