OT ? Access Assured Insurance legal and medical question

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Hi everyone,

Here's an unusual situation a patient related to me. She's uninsured. Had a painful lesion on her leg that looked like the necrotic affect of a spider bite. It covered the entire tib anterior and part of the lateral gastroc. It was bloody and blistered with gray, green and obviously infected tissue. She also had a very large painful calcific tumor in the uterous (fibroid taking up 80 % of the uterus). She presented to me and I told her she needed to see PCP.

Looking for some expert advice, she went to OHSU to see about care. After calling the OHSU helpline, she got an appoitment with a PCP. She told the front desk receptionist that she had no insurance and would pay cash. The receptionist explained that they had a new program called 'access assured". If she paid $250 it would entitle her to see any doctors on a list that she was given. The list was impressive with all the specialties she needed. She asked, "Is there any other charge besides the $250?" The receptionist told her "NO, there are no other charges. This fee includes seeing all the doctors in the plan." She said that sounds great, "do you have paper work that explains this?" The receptionist told her the program was so new, she didn't have any paperwork, but assured her it was a 'flat fee' that guaranteed she could see all these doctors for no other cost for up to 6 months. She scheduled 3 total appointments. On the first appt, she dropped off all the diagnostic studies she'd paid for outside of OHSU facilities in the hopes it would expedite a diagnosis. She again asked for paperwork on the "access assured program". Again she was told they didn't have any paperwork yet. But again, assured her she'd already paid her $250 and there would be no other bills. She left an ultrasound, x-rays, blood test and other materials for the PCP to review for their next appt. She showed up and the PCP said she had not every been given the materials the patient left behind 2 weeks prior. She left the room 2 times to try to find the hand carried materials and never could. The PCP recommended other tests that needed to be done, but the patient said she already had those tests and didn't want to get them again. The patient finally agreed to a blood test thinking, "well it's covered anyway." The encounter time was non-productive for the patient. The doctor spent about 15 min with the patient and 25 min looking for things out of the room. She received a $170 bill for that visit. She began receiving other bills for the first and second encounter and thinking these were just 'routine' to show how much she saved, she just filed them and didn't pay. On the 3rd appointment, she again asked for paper work and asked about all the bills she was receiving. They told her, she had to pay for ALL the doctor and lab fees in addition to the $250 bill. They told her that the $250 ONLY gave her the right to see these doctors, it didn't cover any fees in their office! She said it was never explained like that and she wanted her money back. She tried unsuccessfully to deal with the off site billing departments and was told essentiall to go blow it. She was taken to small claims collections. She had 3 arbitrations in small claims court. The bills are almost doubled now with court costs and delinquent fees, collection agency fees etc. She has a court date scheduled and the judge told her that a 'consent to treat' is not required to make her responsible to pay the bills. The collection agency presented a 'contract' that access assured gives it's client/patients. It was given to her for the first time (and is dated -she showed it to me) approximately 5 months after her last appt. She never signed any contract, or was given one. The collection guy admitted that she hadn't signed agreement to this, but said that didn't matter. She's still responsible to pay.

My questions:

1. Does this sound like an insurance plan of sorts?

2. And if so, shouldn't there be a requirement that the patient signs something to agree to the terms?

3. If she never signed agreement, can they still hold her to the contract? It seems obsurd.

4. Even if she prevails in this small claims court, she still has to return with a counter suit in small claims to get a refund, right?

5. If this is a type of insurance plan, shouldn't the doctor's offices that participate be responsible to make certain the patient's they trap in this snare, sign the contract? With the OBCE, doctors are responsible for all outside marketing and sales to patients. You can't hide behind well, "goupon did that." Ultimately the doctor is responsible for this type of contract.

Any advice would be greatly appreciated. I only knew to suggest that she could file complaints with the Medical board on each doctor office she went to that billed her or is trying to hold her to a contract she never signed or agreed to. My fear is that the judge will say because she went for care she has to pay. I would argue that she was in such distress and pain and it's not her fault that they have untrained staff at their front desk. I don't think it was a malicious entrapment scheme, just lousy front desk protocols used on a patient in a lot of distress and pain.

Minga Guerrero DC

abowoman@...