Do I need to pay the bill for a doctor's mistake?

November 10, 2023 5:04 AM

I went to the doctor to have something biopsied recently. The doctor did the whole procedure, closed me up, etc. Then when they did some imaging afterwards, realized the thing they biopsied wasn't the correct thing - it was the thing next to what they had biopsied.

So then they needed to re-prep me for another biopsy and go through the whole process of taking another biopsy. And even though the first thing didn't need to be biopsied, they sent that sample for testing also. Now I have the bill from the hospital (my insurance covered most but I have deductible/coinsurance), and I'm being billed for all of the biopsies done rather than only the one I was supposed to get.

Is it worth calling the hospital billing department to explain what happened and see if they might remove the mistaken procedure from the bill, or is there some other way I should approach this? It's not a ton of money so I'm not looking to get a lawyer involved.

posted by anonymous to Law & Government (11 answers total)

It's always worth calling the hospital billing department! Your explanation here is very clear and unemotional, which is an effective way to speak with admins. Go for it.
posted by phunniemee at 5:14 AM on November 10, 2023 [25 favorites]

Yes. This is their mistake and they should eat the cost of it. In my experience hospital billing departments are a mixed bag in terms of writing off charges when patients request it, but your hospital may have an in-house patient advocate who is able to help navigate that. If you need assistance, many states also have consumer assistance programs, which are independent advocates who can help you with this free of charge.
posted by gauche at 6:27 AM on November 10, 2023 [7 favorites]

There also is a grievance process. An incident like this should have been reported through where ever they track patient harm, because an invasive procedure in the wrong place is a big mistake and should be reviewed thoughoughly. Your hospitals patient advocate people ( sometimes this is called patient guest services, patient support, guest experience, there's a bunch of similar sounding names for this) can let you know if that happened or not and help with the billing part as well.
posted by AlexiaSky at 6:32 AM on November 10, 2023 [30 favorites]

IANAL, IANAD, but surely they should compensate you for unnecessary surgery, not charge?
posted by Phanx at 7:51 AM on November 10, 2023 [8 favorites]

Many hospitals have what's called an "ombudsman", they're sort of a patient advocate and can assist in resolving problems like this.

(Be aware they still work for the hospital, so they're not 100% on your side even though that's their job, so don't take legal advice from them or anything)
posted by AzraelBrown at 8:58 AM on November 10, 2023

How big is the hospital? Is it out in the middle of nowhere or is this an accredited large hospital? If it's a big one, you might want to call their Patient Advocate office and mention "Joint Commission Sentinel Report" and see how fast and how high they jump. Ask them for a copy of the Sentinel Report filed on your behalf (they may or may not have done this). It's a big deal; they should've filed one since they operated on the wrong site.

There is supposed to be what's called a Time Out before they start operating where everything and everyone must stop what they're doing and go over your name/dob, what the procedure is, where they are doing it and it all gets confirmed. Your doctor also should have seen you before your surgery and signed his initials with a surgery marker at the location he was going to work on. The owness was on more than your surgeon. It also fell to the head RN, anesthesiologist, etc. Proper procedure wasn't followed.

Here is information about the Joint Commission. There is also information about how you can report the event yourself.

From page SE-4 Identifying Sentinel Events:

Surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome


invasive procedure A procedure in which skin or mucous membranes and/or connective tissue are incised or punctured, an instrument is introduced through a natural body orifice, or foreign material is inserted into the body for diagnostic or treatment-related purposes. Examples of invasive procedures include central line and chest tube insertions, biopsies and excisions, and all percutaneous procedures (for example, cardiac, electrophysiology, interventional radiology). Exclusions include venipuncture, which is defined as a collection of blood from a vein. Note: This exclusion is still considered a patient safety event and should be reviewed by the appropriate local quality and safety teams.

posted by dancinglamb at 9:00 AM on November 10, 2023 [23 favorites]

As an FYI Dancing lamb is 100% on target for the exact wording to get people to take you very very very seriously. I didn't use those terms above because I generally take a softer approach to things.
posted by AlexiaSky at 10:04 AM on November 10, 2023

Fully agree that calmly mentioning JCAHO (Joint Commission) is a good strategy, as is whatever state agencies regulate medical care and track medical errors -- here in Florida, it's the Agency for Health Care Administration and the state Board of Medicine, YMMV.

Honestly, if the hospital is on the up-and-up, they've already reported the error, which may take away some of your leverage. But here's something else that can work. I worked for several years as the regional newspaper's healthcare investigative reporter. I can't even tell you how many times this dance played out:

1) Person calls me about hospital/doctor committing some sort of error. (Did you know that the blankets they drape on you after a procedure can get so hot they literally burn skin? Ask me how I know!)
2) I call the hospital/doctor and say, hey, this patient tells me your literally burned their skin with blankets that were too hot, etc.
3) Hospital /doctor says, umm, we'll get back to you on that.
4) (Hospital/doctor and patient negotiate some sort of settlement on the QT.)
5) Person and hospital/doctor stop returning calls or give me a no comment.

Kinda crappy, but I didn't mind if it helped someone get the restitution they deserved.
If you still have a halfway decent news organization in your area, you can give this a try if all else fails.
posted by martin q blank at 10:47 AM on November 10, 2023 [3 favorites]

Your insurance company needs to know what happened. You say it is not much money for you but they probably paid more than you did. They might also put pressure on the hospital to correct their billing. You are just one patient, but the insurance company is the real cash cow for the hospital. I’d request a full refund to you and the insurance company for the botch, or at least for them to do the correct procedure completely free of charge. This includes labs and other bills that might not be included in the hospital’s charges.
posted by soelo at 11:05 AM on November 10, 2023 [3 favorites]

Just to offer a different perspective—only OP has the requisite information to know what type of situation we're dealing with here—from what has been shared this sounds like it could be somewhat more commonplace and less "sentinel" than the replies have assumed. The canonical examples of wrong site procedures are amputating the wrong foot, or draining fluid from the left lung instead of the right—absolute bonehead mistakes that can always be prevented.

What OP describes sounds possibly to me like a technical issue with biopsy, which, as a person who performs invasive biopsies, is unfortunately a known complication of the procedure. Depending on the size of the target, ease of access to its location in the body, etc, it can happen that despite our best efforts we discover that whatever we biopsied was not what we intended; most commonly this realization comes from a pathology report saying that what we sent to the lab was completely normal tissue, or not the lymph node we intended, etc etc.

Depending on the procedure and the clinical scenario, sometimes we will do as your doctor did and bring the patient back for a repeat of the same biopsy, often we will perform the biopsy with a different technique (since we weren't able to quite get there the first time), and sometimes we will conclude that it is not worth trying again, either because it would be dangerous for the patient to have a second surgery or because we think it is so technically difficult to get to that particular location that it just won't be possible.

To be perfectly honest with you, I have no involvement in the billing process—I get paid exactly the same no matter what procedures I do—so I have no idea if patients are still billed when their biopsy is "non-diagnostic" (the term for any biopsy where the tissue that is collected cannot be used to make a diagnosis, whether because it's not enough tissue or it's from the wrong place), but I suspect they are, since this is, as I said, a known complication of the procedure. Some percentage of biopsies will always be non-diagnostic because the body is complicated and physicians are imperfect humans who are, ideally, just doing our best. None of the above applies if your doc simply didn't prepare and fucked up, which unfortunately does happen.
posted by telegraph at 1:38 PM on November 10, 2023 [1 favorite]

Some years ago I was having breast implants as reconstruction after breast cancer. My surgeon recommended that I have the implants placed sub-glandular rather than sub-muscular, for a variety of reasons including that I tended to work out my upper body a fair amount. On the day of my surgery, it was delayed quite a long time and when my surgeon came to apologize and say that a prior surgery took much longer than anticipated and that it was now my turn, I said, "Have you had anything to eat? Have you had time to step away and refresh? I absolutely have no problem coming back another day." No, he insisted, all was fine.

Then on the way to the operating room, I asked the nurse whether the hospital followed the WHO checklist and was assured that they did.

A week or so after the surgery, I began to run a fever. I had an idea that I was harboring an infection because of the way that some pre-op procedures were handled. I called the doctor's office and they said that I might have a fever but it had nothing to do with the surgery. I got through it with fever reducers but honestly wasn't thrilled that I wasn't offered antibiotics or at least an office visit.

Then a bit later, I went for a follow up and told the surgeon that the sensation of the implants bouncing around in my body was incredibly disturbing -- it felt like there were live animals jumping around in my breasts when I would pull open a door or whatever. He looked at my chart and looked at me, and then.... asked me whether we had discussed placing the implants over the muscle. I said yes we discussed it and agreed to it, why? Pause pause pause, then he said he had placed them under the muscle. We scheduled a second surgery and this time I made sure that the nurse running the checklist knew that the implants needed to be sub-glandular.

Not long after that surgery, one of the incisions opened up. I called the doctor's office and said that I was concerned. The receptionist told me that there was nothing to worry about. I said I wanted to see the doctor anyway. When I went to his office, I was first seen by a nurse practitioner who told me that I was over-reacting. Then the doctor came in and said, this happens, it's fine if it's just the outer incision, don't worry. Then he took a look at it and asked me if I had eaten anything in the previous 12 hours. I had eaten half a bagel so he scheduled the surgery for the next day and put me on an antibiotic. That time I was given drains and a LOT more post-op instructions. When I returned to have the drains removed, I saw a different practitioner -- I don't know whether he was a doctor or what, but in any event I didn't know what to expect and I was given no warning at all and having the drains ripped out was just really disturbing because it's a very weird sensation and I was already a little bit on guard when I was in that office.

I had one more follow up, this time after everything was healed up. It looked weird but I was really over having surgery so whatever, right. But I took that opportunity to tell the surgeon every thing that I felt was problematic with my care including things like how I was told that the incisions would be around my areolae and so there would effectively be no scarring and that was NOT the case, and I had not been told that there could have been another outcome (this all happened in 2009 and to this day I have pain where the incisions were eventually made, under my breasts), and things like why wasn't I told that having the drains pulled out would be a little weird. I told him that the care I received at my piercing studio was clearer and more antiseptic than any care I received from his practice. I told him that I would have appreciated being told given accurate information about the way my breasts would actually look like, that I shouldn't expect my breasts to look normal or that my one stated goal -- that they be the same size at the end of the day -- was also unlikely or certainly not guaranteed. None of that was told to me. And oh yeah he knew I was a lawyer so when I said "informed consent" he knew I was really sad and upset.

I never said that I was going to sue him, and I never intended to do so. I just emphasized that I wanted to be sure that no one else had the bad experience that I had what with being told that I was overreacting, that my concerns were brushed aside, that I thought I had taken precautions so that mistakes wouldn't be made -- offering to come a different day for surgery, asking him if he needed a break, asking whether the WHO checklist was used, etcetera. He listened but I don't know whether he heard me, if you know what I mean.

However, and this is the point, I never paid him a fucking penny and I am pretty sure I only ever got one bill which I promptly threw away. After all that? No. I wasn't going to sue him but by god I was not going to pay for that bullshit.
posted by janey47 at 3:25 PM on November 10, 2023 [8 favorites]