My insurance company wants to sue my 3-yr-old

In an effort to not have to pay the ER bill I incurred, Captial BlueCross is suggesting I go after my preschooler for the money.

Let me explain. One nice, quiet, peaceful summer evening, as I was putting my then 2-year-old son to bed, he retaliated by sending me to the emergency room.

OK, not exactly, it wasn’t intentional (so he says), but he threw his head back, straight into my mouth, splitting my lip open vertically across my unstraightened teeth.

After the blood stopped gushing, I gathered the courage to examine the inside of my lower lip, discovering it split almost completely through to the other side. Opened up just like, well, a pair of lips.

When I got to the ER, I explained to the admitting/intake clerk what happened – that my son’s head struck my face, splitting my lip open. She shook her head, took notes, gave me a bracelet and told me to have a seat.

As an aside, it occurred to me as I waited that anyone who opposes state-run medical facilities for fear of having to wait to see a doctor has never actually been to an “emergency” room. No, I was not in mortal peril – it was evening, and a weekend, so there would be no GP to consult. Still, I waited most of the evening to see someone.

I eventually did see the triage nurse. He took a look inside my mouth and concluded I would require stitches. When he asked how I came to have this injury, I reiterated the above story. He was amused, but not unsympathetic.

I was then admitted inside, and proceeded to wait further to see another medical professional. An attending nurse prepped the room, pulling out all manner of instruments for suturing deep lacerations. And then I waited some more.

Eventually a doctor’s assistant (I believe – in any case someone capable of attending to my injury and making a qualified examination thereof) came in and said that my lip had mostly healed already (!!). I could have stitches if I wanted, but that itself would be painful, and that area of the mouth heals very quickly (I didn’t think I had waited that long). So off I went back home, with my discharge papers, new bracelet and an ER co-pay bill in my hand.

To the point of this story, I did tell the attending doctor(‘s assistant) the same story about how my lip came to be that way.

Months go by, and I get the Explanation of Benefits from CBC. They’re denying payment, because they’ve come to believe that the injury was the result of an auto accident (?). They suggest filing a claim against my auto policy.

The part of my brain that believes conspiracy theories wondered if they were trying to weasel out of paying – “clearly the nature of your injuries suggests they were sustained in an automobile accident” – but having a wife who works in the health care field, I understand how someone could write down the wrong code on a form, and my injury could be misclassified. I call to clear up the confusion.

The clerk I spoke with was more than pleasant. He, like everyone, was amused at my retelling of how my son came to bust me in the mouth. He said he would make the proper notations, and that would be it.

Always be wary when someone in that position says something like that.

I’ve just now gotten a letter – a form to fill out, actually – an “Other Party Liability Report.” My “contract contains a Subrogation provision that includes the right of recovery for benefits provided when a third party has first payment responsibility.” In other words, tell us who’s responsible, so we can go after them for the money.

They want to know if it was (again) the result of an auto accident, or was work-related. Under “Section 2 – Complete this section if another person or party was responsible for the injury/illness,” it asks, “has or will the person file a claim against the responsible person or the insurance company?” Then it asks for their insurance information – uncuriously, it’s the same as mine. It then asks if I’ve retained an attorney.

No, I wasn’t planning on suing someone with the same last name who lives at the same address, who’s on my insurance policy. Yes, I know forms like these often get kicked out automatically by “the system” and that they’re usually applicable, but considering everyone involved should know by now how it happened, I shouldn’t have to explain it again.

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Published in: on November 4, 2009 at 3:01 pm  Leave a Comment  
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