Pete, Good Morning!!!! I have aproval letter sended by the Insurance company to the Hospital. Princess just direct me to the Insurance company. here is what they send:
GLOBAL MEDICAL MANAGEMENT, INC ~PH.. C·.s· l 7901 SW 36th Street, Suite 100 ~ PH CSDavie, FL 33328 USA PRIVATI: HI:UTilCARE S'(STEMS'f ITEL: ( 954) 370·6404 FAX: (954) 370·8130Hospital:St LuKes Episcopal HospitalContact:Address:City:ATTN: JuliaXXXX XXXXXXX XXHOUSTON, TX XXXXXXXXX br />Fax:Phone:(713) 798·8862(713) 798·8010Last Name: Gonzal'ezFirst Name,: Juan CarlosDaB: May 12,1962Policy #: XXXXXXXXX br />Re: Diagnosis; (48140) Dx. Unspecified disease of pancreasDate of surgery: 04/14/2008Co-payment: NoneDeductible: NoneInfo: We guarantee payment of expenses in connection with hospitalization of the patient insemi-private room. This guarantee covers only hospitalization, acute treatment,medication and examinations necessary and relevant to the dIagnosis. Expenses mustbe reasonable and customary according to local standards.Insurance Carrier: MHG Princess Cruise LinesGlobal Medical Management is the auttlorized representative for the above·mentioned InternationalInsurance Carrier in the US. Please note that this is an International Insurance Carrier and that allbenefits are based upon eligibility and SUbject to plan provisions.Upon receipt of original US-04 1 HCFA·1500 the claim will be processed in an expeditious manner byGlobal Medical Management per our PPO affillation through PHCS.Please make sure that the patient signs the appropriate form Which entitles us to the releaseof medical information (authorization of medical release),Io assure that services are covered under the policy. YOU must verity coverage I2l'iortoproceeding witbany non emergeDt medical treatment. If emergent serVices are rende,redGlobal Medical Management needs to be notified wIthin 24 hours.MAIL ORIGINAL CLAIM (UB..o41 HCFA·15(0) ANDITEMIZEiD BILL TO GLOBAL MEDICALMANAGEMENT AT THE ABOVE ADDRESSShould you need further information, please do not hesitate to contact us.Thank you very much for your cooperation.Sincerely,XXXXXXXX XXXXXXX.XXXXXXXXCustomer Service Representarive__________ 7 _CONFIDENTIAL DOCUMENT FOR GONZALEZ, JUAN CARLOS, MRN: 02744807, ACCOUNT: XXXXXXXXXX Printed by: zjamO·Insurance Card - Page 2/2[Single Page Printed] Job 6596 (05/28/2008 1411) - Page 1 Doc# 1
I am not a US citizen, I am legally in the country with a B-1 B-2. I started working for Princess Cruise Line since February 26, 1986. On November 24, 2007 my 9 month contract expired. At this point in time I was on vacation, expecting to return to work in February of 2008. According to their policy my medical insurance was supposed to cover me for 3 months after my contract expiration date. On December 7, 2007 I attended my physical examination and on December 11, 2007 I was notified that I had kidney stones and a tumor in my pancreas. Upon this diagnosis, I immediately notified Princess Cruise Line and my medical insurance company. Prior to my pancreatic surgery, the hospital notified the Princess Cruise Line and they [the medical insurance company] agreed to cover the cost of the surgery. On April 14, 2008 my surgery was performed at St. Luke's Hospital in Houston, TX. I was discharged from the hospital on April 21, 2008, and returned to the emergency room on April 24, 2008 for a second surgery due to a severe infection. I believe I was improperly discharged following my initial surgery, and contracted the infection as a result of the first surgery. I was finally discharged on May 16, 2008. St. Luke's Hospital sent me an invoice in the amount of $121,000.00. The medical insurance company refused to cover the amount, and any other medical bills related to the surgery. I requested assistance from Princess Cruise Line in this matter and they refused to support me despite my 21 years of service to them. I am desperately seeking your legal advice, as both my medical condition and financial situation are grave.
Optional Information: TexasAlready Tried: For four months I was consulting with a lawyer and he told me at the end of the consultation that he knows very well the doctor and he can not continue with my case. And this particular doctor help the lawyer with a case in court.
JKarlos. . . here are my thoughts. . .. . you relied upon the express written authorization and representation of the insurance company that the surgery was covered by the policy and would be paid in a timely fashion. The sequence of medical events all appear to be related to the initial date when the company agreed that there was coverage. If the company made an error in deciding the coverage question, that is not your fault. In fact you relied on the company's representations to your detriment. Had you known that the coverage was different or not applicable, you may very well have made much different decisions for your care and treatment. The law affords relief in your situation through a doctrine called promissory estoppel or equitable estoppel. You relied upon the representation of the company to your detriment and your actions of reliance should in all fairness be enforced. You need legal counsel immediately because the amount is so large that the care providers will take legal action.
Secondly, as to the medical care and treatment you received, I am not in a position to comment upon. I am not a physician. I do know that there is always a risk of infection associated with surgery. This is something that should have been disclosed prior to your surgery. If it was not, you may have a claim against the physician. In addition, if the infection is a result of improper medical care or unsanitary conditions at the facility that provided you treatment (such as a staff infection) you may have a claims for malpractice for this as well. Much of this will depend on what is reflected in your medical records and care and treatment records and I do not, obviously have access to those.
Contact another lawyer asap so that you can derail the collection efforts and have a legal evaluation of your potential malpractice claims.
I hope this helps.
Pete
Attorney
Personal injury trial lawyer for 19 years.
Pete,
I apreciate you advice and comment, this is a big help for me, and I feel more secure on what I woul like to do, unforutnatly here in Hosuton, TX so far I have not found a Lawyer or a place where to run to request assitance, lawyers are saying that I need to have money in order to pay an expert to check on my records and analize if I was release infected on the first surgery, thank you for time and hard work.
can you please direct me to wich specialist lawyer will be the right one to look for and and wich goverment office is the right one to look for help?