Small Claims Question

[Usui Takumi 1,562]

I mentioned this a few months ago, my wife went to an appointment and a staff member told her she would like to run some lab tests. My wife said no, that she had the tests recently and it was a non issue. They ran them anyway and billed us. Its Kaiser Perminente, so I figured I should at least try and work things out. I followed their procedure and filed a grievance. Their response didn't even address the grievance but at least I have a case manager's address now. So I've written a letter basically saying that the issue was never addressed and I expect it to be addressed during their automatic appeal process. I also added that if the situation is not handled internally I would be filing a small claim in the state. (I checked the contract and small claims do not require arbitration). Anyway I assume I'm allowed to do this correct? I figure it might get them to drop the charges since it would cost them far more to send a rep to court. I've read most businesses when they get the notice often would rather settle than waste money.

Any thoughts?

Ps. So my interviews went well. I have one offer, but I'm trying to get another from the company I really want work for. No matter what though, I think I'll be handing in my resignation this week!

[IR5FORMUMSIE 850]

If tests are run without the consent of the patient it is assault (depending on if blood or other fluids were drawn). I don't see how K-P has a leg to stand on. Keep copies of everything and document all phone calls and other forms of correspondence. That's about it. Good luck with your new job wherever it turns out to be.

[^_^ 5,021]

Ps. So my interviews went well. I have one offer, but I'm trying to get another from the company I really want work for. No matter what though, I think I'll be handing in my resignation this week!

Congrats!

[Gary and Alla 3,694]

I mentioned this a few months ago, my wife went to an appointment and a staff member told her she would like to run some lab tests. My wife said no, that she had the tests recently and it was a non issue. They ran them anyway and billed us. Its Kaiser Perminente, so I figured I should at least try and work things out. I followed their procedure and filed a grievance. Their response didn't even address the grievance but at least I have a case manager's address now. So I've written a letter basically saying that the issue was never addressed and I expect it to be addressed during their automatic appeal process. I also added that if the situation is not handled internally I would be filing a small claim in the state. (I checked the contract and small claims do not require arbitration). Anyway I assume I'm allowed to do this correct? I figure it might get them to drop the charges since it would cost them far more to send a rep to court. I've read most businesses when they get the notice often would rather settle than waste money.

Any thoughts?

Ps. So my interviews went well. I have one offer, but I'm trying to get another from the company I really want work for. No matter what though, I think I'll be handing in my resignation this week!

There would be no reason you would be prevented from wasting your time filing a small claims case. You paid for a test you did not authorize (#######!!!!!) and now you want your money back, rather than let THEM try to collect the money from you. Possession is 9/10ths of the law. They have your money and you want it back.

File your claim now, no need to wait to waste your time. They will not respond and you will win when they do not show up to court. Congratulations. You will then have another piece of paper that they owe you the money. You can frame it and hang it on your wall and tell everyone how you defeated the mighty Kaiser-Permenente. Or send them a copy and they can ignore more of your mail.

In the future....do not pay for things you didn't agree to pay for. It is ALWAYS better to be sued, than to sue someone.

Edited August 15, 2010 by Gary and Alla

[one...two...tree 2,762]

I mentioned this a few months ago, my wife went to an appointment and a staff member told her she would like to run some lab tests. My wife said no, that she had the tests recently and it was a non issue. They ran them anyway and billed us. Its Kaiser Perminente, so I figured I should at least try and work things out. I followed their procedure and filed a grievance. Their response didn't even address the grievance but at least I have a case manager's address now. So I've written a letter basically saying that the issue was never addressed and I expect it to be addressed during their automatic appeal process. I also added that if the situation is not handled internally I would be filing a small claim in the state. (I checked the contract and small claims do not require arbitration). Anyway I assume I'm allowed to do this correct? I figure it might get them to drop the charges since it would cost them far more to send a rep to court. I've read most businesses when they get the notice often would rather settle than waste money.

Any thoughts?

Ps. So my interviews went well. I have one offer, but I'm trying to get another from the company I really want work for. No matter what though, I think I'll be handing in my resignation this week!

That's great news on the job front!

I'm confused about the billing with Kaiser, they are an HMO, so their shouldn't be any out-of-pocket costs beyond co-pays, right?

Edited August 15, 2010 by El Buscador

[Atencio 43]

Can you even sue a HMO for that reason? The law on this is constantly changing.

Edited August 15, 2010 by Atencio

[Usui Takumi 1,562]

I don't know its a weird situation. I haven't paid the bill yet btw.

That's great news on the job front!

I'm confused about the billing with Kaiser, they are an HMO, so their shouldn't be any out-of-pocket costs beyond co-pays, right?

It is the copay that I don't want to pay. (Its not very large...maybe 210 or so but it is the principle behind it.)

Edited August 15, 2010 by Sousuke

[one...two...tree 2,762]

I don't know its a weird situation. I haven't paid the bill yet btw.

It is the copay that I don't want to pay. (Its not very large...maybe 210 or so but it is the principle behind it.)

$210 copay? Wow. If it wasn't your wife's doc who authorized having the tests taken, then I would write out a detailed letter bring it to the doctor and see if he can vouch that he did not authorize the tests. If similar tests were taken earlier and there are records of those tests, then I think you've got a strong case to get Kaiser to drop the charges. Someone had to sign off on those tests and they are the ones who must justify/explain why they did, in spite that weren't necessary. On the other hand, if these tests are routinely done as a safeguard then I don't think you have much of chance of not having to pay for them, especially if was standard protocol.

[I AM NOT THAT GUY 5,715]

Can I avoid arbitration and sue Kaiser in court?

No. If you are a Kaiser member your HMO contract includes the Kaiser Arbitration Agreement which has been upheld many times by California Courts as legal and binding.

http://www.kaiserinjurylawyer.com/CM/Custom/TOCKaiserFAQ.asp

[Usui Takumi 1,562]

Can I avoid arbitration and sue Kaiser in court?

No. If you are a Kaiser member your HMO contract includes the Kaiser Arbitration Agreement which has been upheld many times by California Courts as legal and binding.

http://www.kaiserinjurylawyer.com/CM/Custom/TOCKaiserFAQ.asp

On my contract it says that small claims are not subject to arbitration.

[I AM NOT THAT GUY 5,715]

On my contract it says that small claims are not subject to arbitration.

Are you outside of California?

[I AM NOT THAT GUY 5,715]

Except for Small Claims Court cases, any claim arising from or relating to a

violation of any duty arising from or relating to your agreement with the Kaiser

Plan, including any claim for medical or hospital negligence, for premises liability,

or relating to the coverage for, or delivery of, services or items pursuant to

this agreement, irrespective of the legal theories upon which the claim is asserted,

is subject to binding neutral arbitration. This means that except for Small Claims

Court cases, all parties give up their rights to a jury or court trial.

Interesting. I wonder exactly what that means.

[I AM NOT THAT GUY 5,715]

http://www.examiner.com/health-care-in-national/sue-kaiser-health-plan-and-win