Insurance Companies Hurting Doctors and Patients

A recent 5th Circuit opinion  exposed what is an all too familiar problem for doctors and their patients: health insurance companies refusing to pay for treatment after expressly authorizing the treatment.

According to the 5th Circuit, this scenario "is reenacted each day across the country" and usually unfolds as follows:

• A patient visits their doctor to receive treatment for a medical condition.  
• The doctor diagnoses the condition and recommends a medical treatment plan. 
• For some patients the medical treatment plan may require additional treatments, surgery, and medical devices (implants, prosthetic, other equipment.)
• The doctor then contacts the patient's insurance company to see if the requested treatment is covered under the patient's health insurance policy.
• If the patient's health insurance policy confirms that the treatment or device is covered the doctor then proceeds with the treatment.
• The doctor then sends a bill to the patient's health insurance for the services or treatment provided, but the insurance company refuses to pay what it had previously agreed was covered.
• The doctor then may seek reimbursement from the patient who is unlikely to be able to pay for this unplanned financial burden, which can uncomfortably transform the patient/doctor relationship into the debtor/creditor relationship.  

The good news for doctors and patients is that the 5th Circuit has now decided that even health insurance companies that issue group policies, or ERISA policies, which are normally regulated by a more lax federal law, can now be held liable under more stringent Texas Insurance and Consumer laws.

Therefore if you are a Texas doctor or Texas patient whose health insurance has authorized medical treatment only to deny coverage after you received treatment, you may have a claim against the health insurance company who is now denying coverage.   

Texting While Driving Doubles Reaction Time

A recent study by Texas A&M University's Texas Transportation Institute found that texting, or emailing, while driving doubles reaction time and makes drivers more likely to miss a flashing light.


The study was composed of 42 drivers between the ages of 16 and 54 who drove on an 11-mile (17 km) closed test course while sending or receiving text messages, and again while focusing completely on the road.

In the interest of safety for both participants and the research staff, researchers minimized the complexity of the driving task, using a straight-line course that contained no hills, traffic or potential conflicts other than the construction zone barrels. Consequently, the driving demands that participants encountered were considerably lower than those they would encounter under real-world conditions.

The researchers then asked the drivers to stop when they saw a flashing yellow light and recorded their reaction time.  The typical reaction time without texting was between one and two seconds, but while texting it increased to three to four seconds, regardless of whether the driver was typing or reading a text.

The researchers also found that a texting driver was 11 times more likely to miss the flashing light.

The fact that the study was conducted in an actual driving environment is important. According to research manager Christine Yager most research on texting and driving has been limited to driving simulators, whereas this study involved participants driving an actual vehicle. While the researchers believed their results are more significant since the study was in an actual driving environment they wrote that, "it's frightening to think of how much more poorly our participants may have performed if the driving conditions were more consistent with routine driving."

Perhaps this research will reach some of Texas A&M's more influential elected alums.

Metallic Hips: Dangerous Fail

A recent New York times article reported that studies involving patients with metal-on-metal artificial hips are suffering from health problems, including tissue destruction, as the hips shed tiny pieces of metallic debris.  


The article describes one particular case where the surgeons removing of one of these dangerous artificial metal hips saw, "a biological dead zone...[with] matted strands of tissue stained gray and black, [and] a large strip of muscle near the hip no longer contracted."  


More frightening than the destruction caused by the dangerous metallic debris from the artificial hips is that some patients have no obvious symptoms, like pain, to warn them that there tissue and muscle is being destroyed.

Semi Truck Hits Train. Distracted Driving to Blame?

On Friday June 24, 2011 a semi-truck operated by John Davis Trucking Company, Inc. out of Battle Mountain, Nevada ran through a railroad crossing outside of Reno, Nevada and into an Amtrak passenger train  leaving six people dead and five passengers unaccounted for.

According to an Associated Press report, the crossing gates and blinking lights should have been visible a half-mile away. However tire skid marks at the scene, purportedly from the semi-truck, were less than 300 feet away from the crossing which has led authorities to investigate whether driver distraction or mechanical failure may be to blame for this tragedy.  Both of these possibilities seem to be plausible based on the truck driver's record and the trucking company's history.  More specifically, the trucker's driving record includes three speeding tickets while driving a commercial vehicle, one ticket for driving while talking on a cell phone, and the trucking company has been cited by the Nevada Department of Public Safety numerous times for crashes, unsafe driving, and for operating a truck with tire treads so exposed it had to be taken off the road.

As state and federal authorities continue their investigation they will undoubtedly try to extract data from the semi-truck's "black box," as well as from other electronic data that is stored on the truck's equipment.  This electronic data can often reveal the speed of the truck prior to the crash, the braking time before impact, and whether or not the driver was using a cell phone or other electronic communication device.  If you or a loved one are ever injured by a semi-truck it will be imperative to gather this same type of evidence, and if you should chose to hire a personal injury trial lawyer to help you do this make sure to ask the attorney if they have experience in retrieving this type of information.

Ruptured Disc Forces Man to Rob Bank?

The ABA Journal recently reported that a North Carolina man robbed a bank to get prison health care for his two ruptured discs.  According to the report, 59 year old James Verone walked into a bank, handed a note to a teller demanding $1, and then sat down and waited for the police to come arrest him.

While Mr. Verone's method of receiving health care is by a criminal act, his action highlights the seriousness of the pain of ruptured discs and the lengths someone is willing to go in order to receive medical treatment.

You can learn more about a herniated or ruptured disc form these links:

• Cedars-Sinai Hospital
• Mayo Clinic
• Web MD

Perry Vetoes Texting while Driving Ban

Although several cities in Texas, including Austin, already have a city-wide ban on texting Gov. Perry declared in his veto statement to HB 242 that a state-wide ban on texting while driving would be, " a government effort to micromanage the behavior of adults," and that the current Texas law prohibiting teenage drivers from texting while driving is sufficient. Gov. Perry also stated that, "the keys to dissuading drivers of all ages from texting while driving are information and education."

Gov. Perry did not draw a distinction between texting while driving and other harmful driving behaviors that the State has deemed worthy of curbing by both education and civil/criminal penalties, e.g. Click It or Ticket campaign and the Faces of Drunk Driving campaign.  In light of this veto, it is interesting to note that research has shown that talking on a cell phone impairs a driver's reaction time as much, if not more than, drunk driving.

The Texas Department of Transportation currently promotes a public awareness campaign called, "Talk. Text. Crash" which refers to distracted driving as a "deadly trend...in Texas, where nearly one in four crashes involves driver distraction."  Apparently Gov. Perry believes that the best way to curb this deadly trend that kills hundreds of Texans every year does not include any civil or criminal penalties.  If you desire to express your opinion either in support of the Governor or in opposition you may contact the Governor here; the text of the vetoed bill can be found here.

Bounce House Hazards; Special Alert to Parents

A 2009 memo from the Consumer Product Safety Commission ("CPSC") estimated that there were over 31,000 emergency department treated injuries associated with inflatable bounce houses in between 2003 and 2007 in the U.S.- that's over 17 trips to the emergency room a day.

The CPSC's memo also revealed that during that same period there were four reported deaths, most of which involved someone falling off or out of the inflatable and then hitting their head on the hard pavement nearby.

Now as summer vacations get underway parents will undoubtedly be hosting or taking their children to birthday parties or gatherings with inflatable bounce houses.  While these bounce houses look soft, safe, and fun for children of almost any age the CPSC's data tell a different story, and  a recent article in the Washington Post revealed several shocking stories of how improperly staked bounce houses have been blown across city streets, swept away by wind gusts, or toppled by excessive weight.

Before letting your child enter a bounce house or other inflatable jumping device make sure to check that:

1. The inflatable is properly secured and staked; 
2. The inflatable is not over crowded with children;
3. The inflatable is not tattered, worn or patched; 
4. Your child is never unattended and someone is always watching the inflatable; and
5. The air flow from the motor to the inflatable is not obstructed.