[Please do not quote]Not legal advice. If you take legal advice online, then you are stupid. Doesn't matter who or why; I've seen it go wrong.https://www.arezamedical.com/product-page/antibacterial-alginate-silver-dressing-5"Alginate with Silver" Those are the good, expensive dressings they don't break out most of the time.
Medicaid, Medicare and the VA usually only pay for these when infection or drainage happens.
"They did ask permission to show the pictures to the Utilization Review Committee in their hospital and I said they could see the pictures."
https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-C/section-482.30The hospital is required to have and use a utilization review in order to be able to receive payment from the government funding sources (e.g. Medicaid, Medicare, VA) for anyone (not just you but for them to pay them for anyone at all from those sources). The hospital must account for the services it provides and this may invoke quality tracking standards. They have to deal with this properly or face lovely consequences.
"I told them I was not signing anything and the doctors didn't seem to care or mind that part at all."
Three doctors:
First, good job on the not signing anything.
Don't panic, because it looks like it is being addressed but someone messed up, probably the original doctor, which is why the older doctor is doing the talking and brought along the specialist doctor. The older doctor is probably in charge and steps in when stuff like this happens.
This is the hospital engaging in "mitigation." If you or someone ends up suing, they can show they acted properly and timely dealing with the situation under their compliance obligations through their compliance officer, who is an attorney (or absolutely should be if they don't want sued by someone like me, which has happened in the past but I am not in a position to do so now at all).
This doesn't necessarily get them off the hook, but they might be worse off if they just ignored it.
Remember those pictures I mentioned earlier.... THIS. This is why.
If it doesn't get better, then they have a potential lawsuit on their hands and you could look into a lawyer. However, hopefully it will get better and it sounds like the wound care specialist physician is the right general track. Keep taking those pictures and records of things because if someone tries to change their story later, that will pin them down to what actually happened. I am glad to see it seems to be improving. Document this well, because then they can't sweep it under the rug, or if they try to anyhow it can majorly come back to bite them in the ass. I've seen hospitals and doctors try to do this before and it gives the rest of the doctors a bad name they don't deserve and a lawyer a lovely malpractice lawsuit.
Take those pictures on a daily basis, because you are gathering evidence to scare these hospital administrators into shutting up and dealing with the problem. They have said it didn't matter or what something else to avoid responsibility in the past and they can argue with the pictures if they want but it's harder. Harder still to see a second opinion with corresponding notes from a different doctor.
I recommend you A.) Request copies of your medical records to see what these doctors are actually writing in their office visit, progress notes, history and physical or other medical documentation as well as laboratory tests (blood tests), and B.) get a second opinion from a different doctor at a different hospital. Call your insurance company and explain the situation to them to request pre-approval of coverage/payment to see another doctor at a different hospital.
The pictures are very good to have but NOT self explanatory. You need a physician's interpretation of the situation in their expert medical opinion. So you can have them look at it and write down what they see in their charting/notes.
CYA Cover YOUR A@@. Why do you think they sent in that older doctor who did all the talking while the other one shut up? That's what they're doing.
I hope you don't need any of this, but if you do, then it's better to have it and not need it than need it and not have it.
Either way the goal is to get everyone through this situation in the best way possible.
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Topic: Ingrown toenail and missing portion of nail Issues (Read 6966 times)