Detrimental Reliance

What is the name of your state? Michigan

I'm not sure where to post this. So I've posted this in a couple of places.

My wife was hospitalized for 45 days. Her insurance ran out is 30 days. The hospital has a practice of informing patients when their insurance is going to run out. Neither my wife of I were informed that her insurance had been maxed out. I believe that there was an implied contract between my wife and the hospital.

I have found plenty of case law on Detrimental Reliance as it pertains to employment but nothing on medical. Can anyone assist me?

Dave

[ellencee]

Dave
I did find some references to detrimental reliance as it has been used in medical-legal situations, but the only successful case and the only one with any real relevance was a case that dealt with suing an HMO for vicarious liability for the actions of the HMO's contract physicians.

In reading the different cases with detrimental reliability as a cause of action, it appears you must prove that you were 'duped' into accepting services and payment for services that otherwise you would not have accepted and therefore would not have incurred the costs of the service(s) if you had been properly informed.

After giving this some thought, and going from 'yea' to 'nay' several times, I think you may indeed have some reason to believe you were misled. This is why I reached that decision:

Everyone knew your wife's insurance would only pay for 30 days inpatient hospitalization for the treatment of mental illness, including the physician (right?). The physician admitted her to the facility for 30 days and through that facility, the physician provided medical care (as opposed to his treating her as a private patient in his office). Your wife gave her consent for treatment and billing for only 30 days as it was her understanding that was to be her maximum length of stay.

The decision to continue in-house treatment, discharge, or transfer was the responsibility of the physician.

If your wife was not safe to be discharged home, then it can be argued that she was not competent to make decisions or to enter into a contract for financial responsibility. Her consent for treatment, if considered to be implied consent, did not include a specification as to facility and did not imply consent for private vs state-funded or fee-based facilities or as to which physician.

If your wife gave her consent for 30 days' treatment, it can also be construed that beginning on day 31, the hospital and physician were providing treatment without her consent, holding her without her consent or a court order, and restricting her access to leaving. Providing treatment that included shock treatments and medications could possibly be considered 'assault and battery' and it is possible that by keeping her, it was also 'false imprisonment'. That may be why the hospital withdrew their bill in its entirity.

Can it be implied that you accepted the financial responsibility for days 31-49 by not seeking her discharge when the 30 days was up? I don't think so. You had no contract with the hospital at all and no duty to accept liability for her continued care, unless Michigan law states that you do.

I thought about what a reasonable person would have done in the same circumstances.

If I am in the hospital, my husband (who normally is a reasonable man) loses all normal sense and functioning; he needs a caretaker, too. It would never cross his mind to ask about day 31 and beyond. Someone else would have to think of that for him.

Most of the time I am a reasonable person and I am an RN with many years of clinical experience. If my husband is in the hospital, I am aware of all of the details that need attending. Before day 30, I would have been in the admitting office asking 'what do we do after day 30' and asking the physician's office 'what do we do after day 30'.

For your situation, my husband would be the 'reasonable' person. It is possible that a reasonable person could have simply not inquired about the financial responsibility for days 31 and beyond.

I'm a nurse; I know hospitals keep up with days of admission and financial arrangements; in fact, they accept that responsibility and have departments for just that purpose. Doctor's office's are frequently lax in billing arrangements for MD visits during hospitalizations and simply issue a billing statement after the client is discharged from the hospital. Still, it's their responsibility to make financial arrangements with their clients.

To help you locate additional information that may lend some insight as to their intentions regarding discharge or extended stay and the associated costs, look in her medical records. There will be a discharge planning sheet somewhere and there will be financial papers. The financial papers may be separate from her medical records and would be in a business office associated with admissions.

If a small claims court allows it, you could show the court that the hospital discharged their entire bill with impunity to you and your wife.

I am not an attorney and I do not know if what I have said would stand up in a court of law.

Hey Dave: I think you should take that advice (and the reasoning stated), use it to your advantage, and file a written complaint with someone. I recall your situation from several months ago, and it looks like you're still plugging away at this problem. What ellencee has said is stated well, and I think you should get in touch with someone (the AG's office / consumer protection is who I think of), and file a written complaint with someone regarding that hospital bill for those uninsured days (if you haven't already).

I've attached a URL for Michigan's AG Office that speaks to patients rights, etc. Look at the box on this url that says "consumer protection" (or consumer complaints -- I can't remember which). Best of luck to you.


[url]http://www.michigan.gov/ag/0,1607,7-164-17334_18152-47223--,00.html[/url]



hmmbrdzz

Ellencee and Hmmbrdzz,

Thanks for your input.

Neither my wife or I gave any thought to how much insurance my wife had. My wife wasn't in any shape to think rationally about anything at the time. On my part, I was too busy trying to learn how to be a single parent and give what support I could to my daughter and wife to think about insurance---responsible and reasonable? I didn't learn what my wife's benefits were until after she was discharged, and we started receiving bills from the hospital and her attending physician. As far as the hospital and the attending physician knowing what the limitations of the my wife insurance were, the billing department for the attending physician somehow got the mental health, substance abuse, inpatient and outpatient benefits mixed up. After I contacted the insurance company I notified the attending physician what the true benefits were. If this wasn't so serious I would call my wife's treatment a comedy of errors.

Ellencee, I'm inclind to agree with you as to why the hospital decided to drop their charges. I read some opinions on battery and negligence. I guess I could make a case. I'm not interested in nailing anyone to a cross. I just want to get this outlandish bill from the attending physician off my back. If Detrimental Reliance doesn't work, I have located some good opinions on Informed Consent that should work. I'm also looking into Breach of Contract.

Hmmbrdzz, welcome back to my continuing saga. My account is currently in collections. Thanks to you and others like you who gave me good advice earlier, I have learned how to protect my rights as a consumer when comes to dealing with collection agencies. A hearth felt thanks to all of you.

Dave

Good luck, Dave. I can't blame you one bit for continuing to attempt to get this settled. I'd be real hot, and letters would be flying til' doomesday!! Wishing you the best of luck with this.


hmmbrdzz