'AITA for refusing to schedule a surgery for my niece at my surgery center?' UPDATED
"AITA for refusing to schedule a surgery for my niece?"
My wife's sister is currently living with us due too financial trouble, and she has a kid (she's a single mom) who needs surgery on her spine. I own a surgery center that specializes in that type of surgery, so my SIL asked me if I can set something up for her.
The only problem with that, is because since she doesn't make a lot of money, she uses public health insurance instead of private. None of my surgeons take Medicaid/Medicare patients due to reimbursements.
When I told my SIL about that, I offered to help her find somewhere else (she doesn't want to do the surgery at our local hospital for some reason) and she started to spout BS about how their work ethic is "wrong," (Which it isn't) and that it's corrupt.
Anyways, she told my wife about that, and now she's trying to persuade me to find someone to perform the surgery at my place (Which is weird, because if they don't want to do the surgery they don't really have to), so I'm asking here to see if I'm the AH. My SIL thinks I am, and she's done a pretty good job having my wife try to persuade me over it.
Not long after posting, OP shared an update.
UPDATE: So, me and my SIL spent a good chunk of time looking for surgeons, and we found a pediatric spine surgeon for her that accepted their insurance. We have scheduled, gotten codes, and checked how much insurance would cover.
I'm probably going to pay the deductible for the surgery, and yeah we'll see how it does from here. Scheduled for about 2-3 weeks from now. Nothing too insane compared to some of these.
The comments kept coming in.
Solmaredditusernow wrote:
So she's, in essence, wanting one of your surgeons (and their surgical teams) to do the surgery for free? Or she's wanting you to force one to take medicaid? Questions- is this a matter of pure choice? Meaning could any of your surgeons take medicaid on a whim, or is this a matter of they would have to go thru a whole rigmarole to begin being able to take medicaid?
Does your center periodically do pro Bono type stuff? (dunno if it's the same term as lawyers or if there is another medical version of that concept). Could they attempt to.followw that path?
OP responded:
With Medicare you have to opt out. With Medicaid unless a doctor actually signs up, they aren't enrolled and don't have to see Medicaid patients. They can privately contract with them though (unless you live in Kentucky, but who actually lives in Kentucky?)
So yeah, they can take medicaid on a whim. Medicare is different.
Yes, same term. We rarely (and I mean extremely rarely) do pro bono. Legal stuff.
tatersprout wrote:
NTA.
I don't know why its so hard to understand that you can't force a surgeon to perform a surgery or accept any case they don't want to do. Many doctors and dentists, therapists, etc only accept certain insurance.
There's no law that a private facility has to accept her. She really needs to get a grip on things here. Do any of them realize that the facility, the surgeon, the anesthesiologist, anesthetist, and more would all have to take Medicaid in order for this to happen? Everyone bills differently.
archetyping101 wrote:
NTA. That's simply how your surgery centre runs and that's not your fault. She can have whatever feelings she has about it but it's her job to help her daughter. So if it's morally bankrupt and unethical, surely she wouldn't want it done there so she'll happily find someone who does do it on public health insurance.
This isn't your concern. Your wife should understand this and back off. If she wants to help, she's more than welcomed to help her sister herself. You explained your office policy and that's out of your hands.
2moms3girls wrote:
Wait, so you SIL is living with you for free (it sounds like) with her kid. She is on medicaid/medicare and you offered to find her someone good who would take her insurance for necessary surgery. And she wants more? And your wife agrees? NTA but dang.
dlraetz1 wrote:
INFO: What happens if your surgeon takes an uninsured case? What is the risk to them?
OP responded:
You're doing it for free, so malpractice insurance won't cover you. One mess up and the patient or patient's family will sue you for a lot of money. Money that you don't have insurance to cover.
EDIT: Could be wrong actually, depends on the carrier, and the pro bono provider.
Kayhowardlots wrote:
NTA. Having worked in medical and dealt with insurance companies including Medicaid it is not as cut and dry as just do the work for free or sign on for being a provider for X insurance. It's not like she can't get the surgery, it's that mom doesn't want it done at the local hospital that everyone uses. Mom is being a bit entitled here.
FigForsaken5419 wrote:
NTA. You can ask your surgeons if they are willing to do this one surgery. But they may feel unduly obligated because you are the boss. That's a different ethical question. You should reach out to other surgical centers to see which will accept her insurance options as a peace offering.
slap_a_wrap wrote:
NTA - at the end of the day, it just isn't up to you. Sure you might own the building, but you can't tell the Dr.'s what to do. Your hands are 100% tied. Best of luck.
Neoprenewedgie wrote:
NTA, and it seems to me that lots of people here have no idea how insurance works in the real world. Especially Medicaid/Medicare. And it would be unprofessional / inappropriate for you to ask a surgeon to perform the operation on your niece through the other insurance as a "favor" for you.