Hospital billed me for services that I explicitly refused. Are there any legal ramifications for hospital? (well, my wife). Background - we lost a pregnancy early this year. Got pregnant again. Wife had some spotting during first trimester, became panicky, and rushed off to a hospital. The main thing they wanted to do was perform STD screening. We've been exclusive partners for over 7 years now and neither of us have ever had any STDs, so my wife outright refused. Doctor was flustered and asked what she did want done, and she said an ultrasound to check on the baby. They needed to do a urine test first (checking for HCG levels and what-not) and then after the HCG levels were deemed high enough, did an ultrasound (baby was fine). I wasn't there for the visit (I was out of town) but she called me while waiting for the ultrasound and gave me the full run down, reiterating to me her refusal to have STD testing done. A couple months later and lo-and-behold I get a bill from the hospital, including over $500 for the STD screening she refused. There were some other items on the bill that without question did not happen, so it is possible that this is a billing mistake and not simply them outright ignoring my wive's clear desires. As a result they either billed me for a test that didn't happen, or performed a test that my wife refused. Either way I obviously have no intention of paying for this. The hospital itself has been very obstinate about my attempts to get any information out of them. My goal here isn't some poorly-thought-out plan to sue the hospital for damages. Rather, they made a number of serious billing mistakes, to the tune of about $2000 that I absolutely should not have to pay (the total bill is about $3600). So far they have not been receptive to my attempts to fix this, and I'm trying to find any leverage I can to get them to take me seriously. I'm not above threatening to (or actually) taking them to small claims court over this. I would like to figure out what legislation or regulations might be applicable before I start throwing the word "lawyers" around. So, to recap: My wife refused some specific procedures. The hospital may have performed them anyway and definitely charged us for them (>$500). Are there any specific laws/regulations that this would violate that I can use to get them to take my requests seriously? Update After some more heated phone calls with customer service reps (I got out my grumpy voice, which is not my norm), they eventually assigned a manager/dedicated customer rep to discuss my case with me (took a couple weeks to finally get a call from them). They said they would look into it in more detail, and also suggested I file written requests for all hospital notes from my visit (which I was already doing anyway). After getting the results we determined that (not surprisingly) the procedures which we knew never happened really didn't happen. As a result of the manager's own digging they finally realized that some of the billed services never happened and finally removed them from the bill. However, I was told that the STD screening did happen, that the notes showed the results were discussed with my wife (they weren't), and that there was no mention of a refusal for STD testing in the notes, so those charges would stand. I fully intended to argue more (there were many mistakes in their notes so the fact that there was no record of us refusing the STD screening was meaningless, in my opinion). However, I got distracted by the holiday season. Fortunately, at the beginning of the year (aka a couple months after our last exchange) we got a phone call from the hospital telling us they were taking the charge for the STD screening off the bill. I'm not sure what changed their minds. All-in-all they took about $1700 off the bill. It's still far more than is reasonable (there was an expensive item which I contested which they did not change), but it's a big difference and I'm out of items that can be easily argued so...
There aren't any specific laws or regulations about medical charges. Instead, this is a matter of general contract law, where you have to agree. You have to consent to be treated, and a signature is taken to be evidence of consent. The law does not say that they have to ask permission for absolutely everything they do, the action just as to be in accordance with an accepted standard of medical practice among members of the medical profession with similar training and experience in the same or similar medical community as that of the person treating, examining, or operating on the patient for whom the consent is obtained This law insulates doctors from getting sued. In a situation where treatment is provided against a patient's instructions, you may have a cause of action for e.g. battery. In general, a doctor can't poke you, draw blood, make "offensive contact" etc. without consent, and consenting to one procedure does not "open the floodgates" of consent for any othre procedure. Of course, if the procedure was not performed, you obviously are not liable for the cost (and they are not liable for a non-occurring battery). This may in fact constitute gross negligence. During trial, the primary issue is likely to be whether there is proof that the procedure was expressly rejected. The doctor would probably provide the consent form, and that form may or may not indicate that the test would be conducted. It would not be surprising if the patient never saw an actual form and instead just electro-signed, having been told that this is authorization to treat. Corroborating witnesses would be helpful. From a practical perspective, especially if the billing department is being recalcitrant, this is probably a matter best handled by an attorney who would start with a formal letter summarizing the consequences of unauthorized medical treatment.
If they do a treatment which you didn't consent to and harm you they risk being sued. As such, they get you to sign a consent form to prove you agreed to the treatment and were informed about what was going on and any material risks. They had implied verbal consent from you which is enough legally, but there's a risk that if it went wrong you could claim you didn't consent, they lied about what treatment you had, and they illegally did it. As an example, they often drip something into your eye which can sometimes cause blurry vision for a while. If you had blurry vision after and crashed your car you could theoretically sue them because you say you didn't consent to that and they have no proof you did.
Consider that stuff "court costs" or "court fees." They are actually often things not related to the court, like environmental fee, or emergency medical something or other, or park poop bag fee. Pretty much whatever either the legislature or administrative decision makers what to put on there. And FWIW, if you were not texting get your phone records and bring them to court to prove that you did not send any texts in or around that time.
HIPAA imposes obligations on some people, but not all people. In the case of security and privacy questions, you would consult 45 CFR Part 164. A patient's actions are not subject to government sanctions, so a patient can provide or decline to provide email addresses following their own judgment. A healthcare or insurance provider would be required to securely keep PII under wraps. The regulations also do not impose obligations on unknowing potentially involved third-parties, i.e. no obligation is imposed on Google to know that an individual is using a Gmail account to transmit PII-related information. The medical provider has an obligation to store and transmit such information securely, which would mean for example that they do not send insecure plain text emails saying &quot;Sally Jones at 12345 67th Ave SW was treated for a loathsome disease, we're coding that as 0102, and we want $500&quot;. That obligation is passed on to employees via employment-contractual obligations, for example that may dictate what computer or software you can use to do the job. If the provider passes the buck to the employee (and I assume that the employee is just an employee), they have violated the security rule. In that case, they may be attempting to mitigate the consequences of their actions or at least check if there were identifiable violations of the privacy rule. In the scenario where SmithMed provides all of the infrastructure needed to bill insurance companies, it is not a HIPAA violation to inspect computer logs, email etc. to verify that the employee has been complying with security and privacy policies. It would likewise not be a HIPAA violation to inspect third-party accounts (Gmail etc) to determine whether there has been a security / privacy rule violation. That is as far as HIPAA takes you. Whether or not the ex-employee has an obligation to turn over their email account information is mostly determined by the employment contract, but it is highly unlikely that any such contract has a &quot;gimme your personal email on termination&quot; clause. It is not inconceivable that the employee negligently used their personal account rather than opening a new billing-job only account. Also depending on the email service provider, it may well be a violation of the terms of service to hand over your account information. (Instead, for a certain email provider, the company is expected to set up and pay for a company account). Those are considerations bearing on possible legal impediments to turning over the email information. Needless to say, don't share passwords etc. because that exposes you legally, but that is not about HIPAA.
This practice is known as "rescission". It is legal under 45 CFR §147.128 in some circumstances. The regulation says (a) A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the plan, or under the policy, certificate, or contract of insurance, with respect to an individual (including a group to which the individual belongs or family coverage in which the individual is included) once the individual is covered under the plan or coverage, unless the individual (or a person seeking coverage on behalf of the individual) performs an act, practice, or omission that constitutes fraud, or makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage. The law also prohibits surprises: A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide at least 30 days advance written notice to each participant (in the individual market, primary subscriber) who would be affected before coverage may be rescinded under this paragraph (a)(1), regardless of, in the case of group coverage, whether the coverage is insured or self-insured, or whether the rescission applies to an entire group or only to an individual within the group. (The rules of this paragraph (a)(1) apply regardless of any contestability period that may otherwise apply.) Note that the regulation pertains to insurance plans, and not employers. The employer may in good faith believe that you are stuck with the medical bills, but their opinion does not matter as far as this regulation goes. However, the employer also does not have the right to "declare" on behalf of the insurance company that your wife was covered. If you assume that she had coverage because the employer (mistakenly) said you did, but there was actually no coverage, then that is between you and the employer, or possibly you and the doctor. A prior question is whether she was actually covered in that past period. The contract between the insurance company and the employer might hypothetically state that only employees are covered, and may have accidentally submitted enrollment information with mistaken information ("X is an employee"). Since there was no intentional misrepresentation (we assume), coverage cannot be rescinded. Also note that rescission is retroactive cancelling, not prospective cancelling ("henceforth, you are not covered").
My guess is the answer to this question is going to be in your lease. You likely signed a lease that agreed that you would pay accept this practice and spelled out what ever rights you have to challenge the billings. My guess is they are as limited as the courts will allow in Florida. And the only way to ensure access to those records would be to get the court to compel they provide you with the records. Perusal of the Water codes in Florida does not appear to directly engage this practice(I could have missed it). However it appears that there is code regulating the management of electrical limits the billing to no more than the actual costs to the customer of record(probably your real estate management company.) According the the NCSL (This refers to electrical service. I am assuming there is similar language used elsewhere for plumbing, or that the intent of the law is uniformity of these codes in all utility billings. Where individual metering is not required and master metering is used in lieu thereof, reasonable apportionment methods, including submetering may be used by the customer of record or the owner of such facility solely for the purpose of allocating the cost of the electricity billed by the utility. The term “cost” as used herein means only those charges specifically authorized by the electric utility's tariff, including but not limited to the customer, energy, demand, fuel, conservation, capacity and environmental charges made by the electric utility plus applicable taxes and fees to the customer of record responsible for the master meter payments. The term does not include late payment charges, returned check charges, the cost of the customer-owned distribution system behind the master meter, the customer of record's cost of billing the individual units, and other such costs. Any fees or charges collected by a customer of record for electricity billed to the customer's account by the utility, whether based on the use of submetering or any other allocation method, shall be determined in a manner which reimburses the customer of record for no more than the customer's actual cost of electricity. Each utility shall develop a standard policy governing the provisions of submetering as provided for herein. Such policy shall be filed by each utility as part of its tariffs. The policy shall have uniform application and shall be nondiscriminatory (Fla. Administrative Code §25-6.049). Now here is where the 3rd party comes in. The 3rd party is the one levying fees for the management on your landlord. Granted if you follow the strings ill bet you find that the billing company is owned by the same company that owns your rental management firm. So your landlord can collect no more than what it costs to provide you with the service, but part of providing the service is employing this 3rd party utility management firm.
If you want to take legal action, hire a lawyer. If you want to puff your chest and see if they flinch here is what you do: First let's deal with this arbitration agreement. (There is probably also a jurisdiction agreement in there, ignore that for now.) First you need to find someone to to arbitrate and a place to hold the arbitration. I suggest a babysitter, dog-walker, friend, whatever... just make sure it is a real person. You write them a letter saying that you are exercising the dispute resolution set forth in the terms and that you propose an arbitration by [insert person's name here] to take place at [location] on [date and time]. You are going to mail this to a physical address and should include a sentence asking them to let you know within 30 days if this schedule works for them. Also tell them that you prefer to communicate via email and provide an email address. Mail this letter. Just mail it plain old snail mail. In two weeks write another letter opening with a statement indicating two weeks ago you sent a letter and asked for confirmation of receipt, that you did not get receipt and would they please acknowledge. You have now puffed your chest. Pretty soon 30 days will run and you will go to the courthouse. Hopefully this will have gotten them talking to you and you can get this resolved. What I describe next is an absolute interbreeding and then slaughter of various states' court rules. I hope that more-informed stack participants edit with gusto. If you can't resolve things go to the courthouse and tell the clerk that you want to file a claim in small claims court against [company] for [dollar amount] based on breach of contract. She will give you paperwork to fill out. You will pay her the filing fee. One of the things you will fill out is a complaint, one is a summons. It might be two in one. Here is an random example. It should be a simple form. Keep it all as simple as possible but be sure to describe the facts that support your claim. You might include the fact that they ignored your requests to arbitrate. Take this complaint and summons and serve them on your defendant. To do this you will need to get someone in the company's city to serve it. There are professionals who do this, mail or email them (if possible) the summons and complaint and pay them. They will you with provide proof of service. Now you have moved past chest-puffing and you've thrown a punch. Now you have initiated a law suit. They must file an answer. This means that they must get lawyers involved. You've gotten their attention and it only cost you filing fees. They must now file an answer to your complaint. They will also likely file a motion to dismiss and do one of a few things: 1. complain that you need to arbitrate 2. It will complain that the contract requires legal action in a certain state or county 3. It will complain that regardless of the contract this is the wrong court for any host of reasons 4. they will claim that you haven't stated a valid complaint 5. some other boilerplate stuff. You might have a hearing scheduled to deal with these things, you might deal with them all on a trial date. Now go back to the clerk at the court and ask for a subpoena form. You will have this served on the defendant also - it must name a person. This is a document that requires them to come to court at a time and place. Again, lawyers get involved to quash this. Lawyers = $ so you probably got their attention. Oh yeah, you need to pay a witness fee and travel costs. You can also serve a subpoena duces tecum which requires them to bring documents that you ask for. This needs to be served on the person in change of keeping records. You will probably pay the costs of the documents. The clerk will have forms for you and will describe the process in ambiguous terms while repeating "we cannot give legal advice." You've got your documents, you have a witness coming, you are ready for trial. If you haven't had some sort of hearing already to deal with defendant's motions to get this thing dismissed, you will need to deal with that stuff now. They will claim that arbitration is required. You tell the judge that you invited them to an arbitration that you set up and they refused to come. You show all the paperwork, including your contract with the arbiter. They will argue about jurisdiction, good luck with this one but it's a whole other problem that I can't touch here! If you survive these objections you will tell the story to the judge, you will call the witness and question her, you will present your documents as evidence. In small claims court the judge (or magistrate or referee) might ask the lawyer some questions about facts. Then the judge will bang his gavel and you wait for his decision. If you win come back here and ask how to get your money.
What would be the most reasonable thing to do? Live with it. Oh, and stop breaking the law with your automated emails. Illegality on their part does not justify illegality on your part. Also, it’s likely that this activity has caused your email address to be blocked automatically which may explain why they aren’t contacting you. From a legal point of view, that’s the only reasonable option. You do have valid grounds for a lawsuit for the value of the watermelon but the cost of filing will be a couple of orders of magnitude greater than the value of the melon so doing so isn’t “reasonable”. If you want to vent, the internet offers a wide variety of social media platforms for which that seems to be their primary focus. But that’s got nothing to do with the law.