Perforated Bowel

  I had my lap- band done Nov. 4 2010. In the process my surgeon perforated my bowel. I was sent home the same day and ended up in the ER and emergency surgery the next day. I was sent to ICU following surgery and stayed inpatient for 5 days thereafter. I now am having problems getting my insurance to foot the bill for the second surgery. I have a dollar limit on the weight loss surgery and was going to have to pay around $5000 in addition to insurance. I agreed to this prior to surgery. No problem. Now the insurance company is saying if I wouldn't have had the weight loss surgery I wouldn't have had the bowel resection. So they say it falls under the payment limit. I am looking at $50,000 instead of $5000 now. I can't do this! 
   The surgeon's office and hospital have resubmitted the bills under different codes to see if the insurance will pay it then. I don't know what to do. I may have to sue my doctor in order to get the bills paid. Then, where will that leave me for follow up?
   I never received a bill for the second surgery from my surgeon, so I think she knows it was her fault. When I called originally to notify them my EOB from insurance denied payment,  I was told by her billing person "That's not your fault! You shouldn't have to pay that!". And that's when they said they would resubmit under different codes. But then there is anesthesia, ICU doctor, labwork, pathologist, etc.  And they all expect me to pay them.
Where do you think I should go from here? I know that with any laproscopic surgery you take the risk of perforation. And I signed the consent. Do you think I have a chance in court?

Im so sorry you are going through this.

I had to sign consent forms to on stuff like and to be honest I think becasue you did sign the consent forms that covers the doc because you knew going into the surgery what "could " happen to you .

I had sign that and plus if he thought if he could not put the lapband on safely then he wouldnt do it at all.

But with your signature on papers that keeps the doc on the safe side I would guess . I could be wrong though but I think you would have a very hard time fighting this because you knew the risks going into the surgery that is why they have you sign the papers

The only way you'll know is to actually speak to a lawyer. Find one you like, call the office, mention the magic "m" word (malpractice) and I'm sure they will at least SEE you for free.

You need to talk to a lawyer.  You signed the consent forms which protect the doctor in case something out of the doctors control goes wrong, but when a Doctor injures (it seems knowingly in this case) a patient, even by mistake, in what would otherwise have been a routine procedure you have the right to seek redress.  Once you know what your rights are, approach the surgeon and see if you can work out something reasonable, but you should definently talk to a personal injury/malpractice lawyer.

 
There are several problems here but possibly a solution as well.

Problem... the consent form likely has something in there about potentially causing a perforation. It's a known risk with this type of surgery.  Based on that fact alone I would doubt you have a case against your doctor.

These types of cases are really hard, you did indeed have a huge and horrible thing happen to you but if you look at it from the point of view of an attorney, you have to figure out just how much the case is worth.  Let's say it's worth $75K.  I'll bet you anything from an attorney point of view it isn't worth that much but let's say it is.

You are going to have to come up with money for an expert witness.  You can figure around $40K for that. I know... sounds totally outlandish and unreasonable but that is the cost.  Then you have all the depositions, those are verrrry expensive.  You have to realize that this process will take YEARS.  So let's say you win.  You end up taking about $25K home and you still haven't paid your bills.  This is assuming you would win and I'll bet you don't.

There have been 5 people so far that went to 5 different doctors in the US and the doctors put the band around a wad of fat instead of their stomachs.  Of these 5 people that I am aware of all tried to sue.  They couldn't find an attorney to take it on because while they had legit cases the case wasn't worth even as much as the medical expert.  And speaking of the medical expert, you would have to find one that is an expert in bariatrics that will say that it was purely due to carelessness that a known risk happened.  Know anyone that will do that?  Go against one of his own in court?  They are mighty hard to find.

Another person posting here had a horrific infection that was misdiagnosed.  He went to his surgeon's office with a fever, high white count, and pus oozing from his incision and he was told he was fine.  A year and a half later he is still recovering.  He's had multiple surgeries and has many issues because of this infection.  He has no case, while he has a legit and provable case the attorney could not find an expert witness that cost less than the case was worth.

This girl:

www.obesityhelp.com/member/adwinters12345/

I don't even know if she is still alive or not.  She has no case.  The OR report mysteriously disappeared when the surgeon got a subpoena for medical records.  Without the OR report there is no proof that he butchered her.  Something as simple as that and she has no case. The folks who type up the medical records can't seem to find back up in their records.  Coincidence, not so much.

So you can go to an attorney but I honestly don't think you'll have much luck.

I would suggest two things.  Go to your doctor, be straight up with her and explain that she did this, this is her fault.  Chit happens but she should have seen this before she closed you up. Now this has left you in a horrible position.  Tell her she needs to find a way to get this covered, period.

Also, go to your state insurance commissioners office.  They can be very motivating.  And finally, contact this person immediately:

www.obesityhelp.com/forums/amos/4203241/Insurance-Questions- and-Answers/

Time limits for appeals and such may apply here.

Sorry you had to go through this.  I do hope you are feeling better.

Get  lawyer, perforated bowel does not come under that 'standard" things that go wrong. Your surgeon goofed and put your health at risk and caused an unnecessary complication...I would sue for the perforated bowel too. Good luck

 A perforated bowel is life threatening, and must be repaired. I would get a copy of my chart from medical records including surgical consents, also consider contacting your congressman, they might be able to help you reach the right people in your state. And look for a lawyer that is experienced in dealing with insurance claims. I am so sorry this happened to you, and hope you are recovering well. 

Perforating your bowel while inserting a lapband is not just a small mistake!  The band and the port are placed so far away from the bowel that it is hard to see how any competent doc could touch one while working on the other!

Clearly this is incompetence/negligence. Get a lawyer.

Kate

 I agre with the previous posters... While you sign a consent that they inform you of possible complications and side effects.... I dont think it absolves them of doing it... 

Informed consent is not consent to perforate....That is as far as I know... 
I would definitley speak to a lawyer and see what can be done. It may take just a meeting or two with the hospital lawyers... They do not want a court case....