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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 90483
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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My son was Medicaid pending and had to go to the eye doctor

Resolved Question:

My son was Medicaid pending and had to go to the eye doctor for a physical before having his cataract romoved. Nothing was explained to him and his wife that the nurse who was performing the physical was a contract nurse and had to be paid before the physical. We were waiting in the waiting room and the supposed head administrator called him, Mr Martin she said, so he and his wife went to where she was standing. She proceeded to tell him he had to pay 109.00 dollars before he could be seen. again no explanation, just pay it. they tried to explain to her he was medicaid pending. She said without explaining the situation that if he didn't pay the money he could just leave. this was done right in front of all the patients waiting in the waiting room. needless to say they were embarrassed because they have no money unless he gets SSI or SSDI. he is blind in his left eye and needs this surgery so as not to lose the sight in his right eye. I am footing the bills until he can.
Submitted: 1 year ago.
Category: Legal
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking.

I am sorry to hear your son has been going through this. Under HIPAA, the provider is prohibited from disclosing only personal healthcare information. This issue of billing is not one that is personal healthcare information protected under HIPAA. What this would be considered is an inconsiderate employee who has no tact and needs to be reported to the doctor. As far as the payment, if his medicaid had not been approved yet and the doctor was not willing to risk waiting for the approval, they do have the right to charge.

I understand this is embarrassing and if she disclosed in front of other patients he had medicaid or was pursuing SSDI benefits, then this is something that he could potentially sue for breach of their duty of confidentiality, but in order to succeed on the suit he would have to prove damages. Damages in a case like this are the hardest part of the case, since there is usually no doubt the administrator made the comments in front of others, but proving the amount of damages he suffered directly from her comments could make it so his case would not be worth filing and that can only be determined from an examination of the facts and a little investigation locally by an attorney to see the potential value of those damages.

So it is possible he could make a claim against the doctor's office for breach of their duty of confidentiality, but it will require a damage analysis locally to determine the viability of that kind of suit.



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Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 90483
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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