Hospital Won’t Return Insurance Money

WSVN — You have heard this one: A customer has a problem with insurance company. But you have never heard this: A problem because they think their insurance company is getting ripped off and deserves their money back. It’s so unusual there is only one place to call: Help Me Howard with Patrick Fraser.

When some people say “my insurance company,” they start to stew. When Lynda Auletta says it, she starts to smile.

Lynda Auletta: “I really like AvMed, you know, and they’ve treated me good.”

And unlike people who fight their insurance company, Lynda called us because she is fighting for her insurance company.

Lynda Auletta: “Pushed onto the nerve. Whew! And it’s severely painful.”

A year ago, Lynda was in so much pain she dialed 911.

Lynda Auletta: “That’s all I said to them, is ‘I need to go to Holy Cross,’ and that’s all I really knew, because I could hardly breathe.”

Fire rescue rushed Lynda to the hospital, getting her insurance information along the way. But as they rolled her into the emergency room, she realized it was not Holy Cross.

Lynda Auletta: “And I said, ‘What hospital is this?’ And she said, ‘Northwest Medical Center,’ and I said, ‘Wrong hospital,’ like that to her.”

Lynda got up and called a friend to pick her up.

Patrick Fraser: “How long were you in the emergency room?”

Lynda Auletta: “Thirty seconds.”

After being driven to Holy Cross, they did the surgery. She was fine, and then months later, she got a surprise in the mail.

Lynda Auletta: “I get a bill from Northwest Medical Center, and I am like, ‘What is this for?’ Nine hundred and something dollars, and I am like, ‘What is going on?'”

The bill doesn’t detail what was done to her in that emergency room. Lynda says there’s a reason for that.

Lynda Auletta: “I didn’t see anybody. I mean nobody, no doctor, no intake, no vitals, nothing.”

But when AvMed got the $921 bill, they paid Northwest Medical. This receipt shows Northwest Medical was paid $668 for Lynda’s treatment at the emergency room. Now here is something else you don’t hear often: Lynda was not happy her insurance company paid the bill.

Lynda Auletta: “I want to see Northwest Medical Center give my insurance company their money back. They never touched me.”

Months have gone by. The hospital has not returned the $668 to AvMed, leaving their customer and supporter unhappy.

Lynda Auletta: “I am pushing, and like, nobody is really listening.”

Well, Howard, what can you do if you think a health care provider got paid for something they shouldn’t have?

Howard Finkelstein: “Under Florida’s Patients Bill of Rights, in a case like this, you have the right to be told what the treatment will be and what it will cost. In this case, there was no treatment, there should be no cost, and the money should be returned to the insurance company.”

I talked to a spokesperson for Northwest Medical. I asked why they billed for Lynda’s non-treatment. I never got an answer. They did e-mail me that they had only received $188 from AvMed in Lynda’s case and returned it.

I spoke to an AvMed representative who told me, “We investigated, and Northwest Medical does not deserve the money, should return the $668, but we have not gotten anything from them in this instance.”

AvMed told me they will continue to pursue to get their money back, and expect to eventually receive it. AvMed also told me they appreciate Lynda contacting them to let they know that Northwest Medical should not have received payment for treatment she did not receive.

Howard agrees with that.

Howard Finkelstein: “Give Lynda credit for caring enough to fight for her insurance company, because in the end, if they pay for something that is not delivered, and it happens enough, it affects all our rates. So check your health care bills, and make sure your insurance company is only paying for what you know you received.”

Lynda Auletta: “So I am excited about that.”

Lynda is satisfied that after nearly a year, AvMed will be getting all their money back. Eventually.

Lynda Auletta: “I am so happy I called Help Me Howard, and I want to say thank you very much. Thank you, Howard, and Mr. Patrick Fraser.”

The bottom line, AvMed will get their $668 back because they do business with the hospital. And also, if you get a medical bill that you think is wrong, don’t pay your co-payment until it’s straightened out. And if you have already paid your co-pay and it’s wrong, get that money back from your medical provider.

A simple problem left you feeling sick? Want to insure it gets corrected? Contact us. We will treat you well, and hopefully come up with a cure for your problem.

With this Help Me Howard, I’m Patrick Fraser, 7News.

CONTACT HELP ME HOWARD:

E-mail: helpmehoward@wsvn.com (please include your contact phone number when e-mailing)
Reporter: Patrick Fraser at pfraser@wsvn.com
Miami-Dade: 305-953-WSVN
Broward: 954-761-WSVN