Weird case. Should I get a lawyer or small claims?

[fnord33]

What is the name of your state (only U.S. law)? Alabama


This is a weird one. I'm no sure what I can do about it and appreciate any advice that you may have.

Short version: My wife bumped her head and we went to the emergency room to be sure she was OK. The doctor filled out the two different insurance forms differently. One (for his money) saying she hit her head the other (for the hospital's money) saying that she was there for rehab and mental derangement. Maybe those weren't the exact words, but he basically said she was crazy and on drugs. Blue cross paid him, but won't pay the hospital because we aren't covered for drug abuse or psychiatric (neither of which were in play here). We tried to straighten it out over the coming year, but the doctor won't change the paperwork. He's just being a jerk. It seems that he passed judgment on my wife and now he's trying to make her pay a $1500.00 fine.

Long version
Almost a year ago, My wife and I went to a gourmet beer festival where we drank tiny beers in the hot sun for several hours. Neither of us got drunk. After that we went out for pizza and then came home. My wife was dehydrated and feeling tired so she took a nap. She was getting up from that nap and tripped over a laundry basket in the dark. She hit her head and started speaking gibberish, so I took her to the emergency room. She was completely sober and in full possession of her faculties before we even left the house, but I wanted to be on the safe side. We're insured with Blue Cross. So, it shouldn't have cost us very much.

At the hospital we told them what happened and they stuck us in a room for a few hours. Meanwhile my wife was still dehydrated and they wouldn't let her drink anything, so she got sick. They scanned her brain and brought her back. Later a doctor came in and scowled at us for about two minutes then left. He barely said anything about the head injury.

A few months later we got a bill for $1,500.00. The insurance wouldn't cover the emergency room visit because they don't cover psychiatric or drug related problems. Obviously we were confused. The doctor had apparently filled out the two insurance forms differently. His was filled out right, but the one for the hospital said she was in for rehab and mental derangement. How anyone could get that out of a person walking in and saying she bumped her head, I don't know.

WE talked to the hospital and the insurance company and everyone was very helpful and understanding except for the doctor who is apparently the one person who can fix this. He refuses. He seems to have something personal against my wife, but I have no idea why. Now she not only has a 1,500 bill that we shouldn't have to pay, but also a medical record implying that she's crazy and on drugs. That's going to effect the treatment she receives from other doctors in the future. So he lied on her medical records, defrauded our insurance, and slandered my wife. I would like to make sure that he can't do this to anybody else, but I'm not sure how I should go about suing him. I've talked to a couple of paralegals and they basically said that there wasn't enough money involved to get a lawyer's attention. That's why I posted in the small claims thread. I don't know anything about small claims court, but I can probably find all the info i need in the other posts here.

So what should I do, try my luck in small claims court or try to sue the hospital/doctor, or should I just pay it? I really don't want to pay it. It's the principal of the thing. Also, I'm poor and $1,500.000 is a lot of money to me. Thanks.

 

[HighwayMan]

Later a doctor came in and scowled at us for about two minutes then left. He barely said anything about the head injury.

Seems contradictory. The first sentence says that the doctor did nothing, but the second implies he did something.


Why doesn't the insurance company just look at both forms the doctor filed to see the discrepancy? Is it the same insurance company?

 

[fnord33]

The insurance company did look at the two forms and they seemed to want to help, but there was technically nothing that could be done without the doctor changing the form himself.


As for the contradictory part, he didn't really do anything. He spent most of the minute or two that he was there scowling and talking about her blood test results. She had trace amounts of tetrahydrocannabinol in her system and he acted like she was a full blown crack whore. She designs software for a living. She's a normal upstanding citizen, but even if she had been a pregnant junkie he had no right to pass judgment or to put anything on the insurance claim other than she got a bump on the head. The results of her blood test had nothing to do with the accident. He might as well have put down that she was in for acid reflux because she had pizza for lunch. His whole visit consisted of something like. "You don't have a concussion, but guess what I found on your blood test. Grrrr!" It was weird.

Obviously we would prefer the test results not to come to light, but it doesn't seem like it would be admissible in court as it has nothing to do with the insurance claim. A crackhead robbed most of the houses on my street a while back and when they caught him and we went to court we weren't allowed to say anything about him being a crackhead because it "didn't have anything to do with the burglary." I still think that's crazy. If he traded my stuff for crack then it should pertain to the case. I suppose that would be hard to prove though.

 

[HighwayMan]

But the doctor submitted two different forms with two radically different diagnoses - they don't consider that significant?

So you left a significant fact out of the original story. When was your wife smoking?

While there is nothing here that warrants a criminal prosecution, medically your wife did have a psychoactive substance in her system, which may lend more credence to the doctor's hospital report, especially considering the symptoms you described. Is any of this mentioned in the paperwork submitted to the insurance company?

In addition, I don't care how small the glasses were, drinking beer for "hours" results in effects that are not insignificant.

 

[Hot Topic]

Of course he had the right to say something on the insurance claim besides the bump on her head. You admitted that you and your wife drank allegedly "tiny" beers in hot conditions for "several" hours. You claimed that neither of you got drunk, which is hard to believe, especially since you felt the need to stress that your wife was completely sober and in complete control of her faculties when you left the house after her fall over the laundry basket.

Your story about the crack dealer was irrelevant.