7 On Your Side
Medical paperwork lesson emerges from boy's accident
BURLINGAME, Calif. (KGO) -- It's a day an 11-year-old Burlingame boy will never forget. Luca Gonzalez accidentally severed his own finger in a summer time accident, but what happened in the months that followed is a lesson for all of us.
Fortunately for Luca, doctors were able to reattach his finger and he is now almost fully recovered. What proved to be a bigger challenge has been the family's struggle with the medical bills.
Luca stretches out some clay in an effort to strengthen his reattached finger. It was just five months ago, when summer time play turned to tragedy.
"I was running towards the door and as I opened it, I pulled it, and grabbed [the door] and slammed it like this. I put my hand like this, the door closed too fast and next thing I knew, I looked up and screamed that my finger was gone," said Luca.
Five months later, Luca has resumed normal activity. His father is a paramedic. He quickly stopped the bleeding, directed Luca's mother to put the finger on ice and then rushed him to Mills Peninsula Medical Center as a terrified mom looked on.
"Surgery was successful and they were able to somewhat reattach it," said Irene Azollini, Luca's mom.
Luca pointed out to us how he lost the top of his middle finger on his right hand.
Then came the hard part -- the rehabilitation and dealing with a mix up with the medical bills. The family's health plan, Health Net, refused to cover the medical expenses because the insurance company said the doctor who performed the surgery was out of network.
"It was an emergency to my child. It was an emergency that was just not a broken bone or broken ankle. This was a severed finger to an 11-year-old child and at no time did anybody ever discuss this with us," said Azollini.
The doctor began billing the family directly for over $10,000 in medical expenses. Linda Leu is with Health Access, a patient advocacy group.
"This is definitely not an uncommon practice. This is something we've heard of many times," said Leu.
She says that's because doctors and insurance companies disagree over compensation.
"The problem needed to be worked out between the insurance company and the doctor. And the provider should not have immediately turned to the consumer to try to bill them," said Leu.
Azollini made calls to everyone involved, but got no answers. She ended up making payments to the doctor because she didn't want her credit hurt. She then called 7 On Your Side.
Health Net told us, what they thought was an out of network treatment was actually a paperwork snafu. They said, "What happened was some services came through and were coded as outpatient, instead of emergency. That left her not covered fully."
But Azollini has since received a check reimbursing her for $2,600 in payments made to the doctor.
"Thank you Channel 7 with all your help and helping us with this matter and you guys were great," said Azollini.
Health Net blames the hospital for miscoding the surgeries. The hospital denies making the mistake. Both declined to appear on camera. The bottom line is Health Net is now covering the expenses for the surgery and all is well.
health care, health insurance, burlingame, 7 on your side, michael finney
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