Going to the hospital is a nerve-wracking experience for anyone, regardless of the reason for the visit.

But what happens when healthcare providers make mistakes that have a negative impact on someone’s health? This is a common scenario, and it’s called a medical error. People can suffer a wide range of consequences, from minor injuries to life-threatening conditions. In this article, we’ll explore what is covered by insurance when it comes to medical errors, and how patients can navigate this situation.

What Are Medical Errors?

Medical errors are defined as mistakes made by healthcare providers that lead to adverse outcomes. Adverse outcomes can be physical or emotional harm, or financial damages.

Medical errors can occur at any stage of the healthcare process, from diagnosis to treatment and after-care. Some examples of medical errors include:.

Incorrect diagnosis
Delayed diagnosis
Surgical errors
Medication errors
Wrong-site surgery
Equipment failure
Infections acquired in healthcare settings
Poor communication among medical staff

Medical errors are a leading cause of death in the United States, according to a study published in the Journal of Patient Safety. The study estimates that between 210,000 and 440,000 people die each year as a result of medical errors.

These are alarming statistics that highlight the importance of understanding how medical errors are covered by insurance.

What Does Insurance Cover?

The type of insurance coverage and the amount of protection varies depending on the type of medical error, the patient’s health insurance policy, and other factors. Generally, insurance covers the following costs:.

Medical Expenses

If a patient experiences an adverse outcome as a result of a medical error, their health insurance policy usually covers the costs of additional medical treatment necessary to correct the mistake.

This includes hospitalization, surgeries, medications, physical therapy, and other treatments deemed medically necessary to address the adverse outcome.

Lost Wages

If a patient is unable to work due to an adverse outcome caused by a medical error, their health insurance policy may cover the cost of lost wages.

This is especially important for people who have jobs that require physical activity or specialized skills. Lost wages coverage typically includes salary, bonuses, and other compensation lost as a result of the injury or illness caused by the medical error.

Pain and Suffering

In some cases, patients may be eligible to receive compensation for pain and suffering caused by a medical error. This can include physical pain, emotional distress, and loss of enjoyment in life.

The amount of compensation varies based on the severity of the adverse outcome, the patient’s age and health condition, and other factors.

Legal Fees

If a patient decides to pursue legal action against a healthcare provider for a medical error, their health insurance policy may cover the costs of hiring an attorney and other legal fees associated with the case.

This is important for patients who may not have the financial resources to pay for legal representation on their own.

What Is Not Covered?

While health insurance policies generally cover a wide range of medical expenses related to medical errors, there are some costs that are typically not covered. These include:.

Punitive Damages

Punitive damages are awarded in some cases as a way to punish the healthcare provider for their negligence or misconduct.

While some states allow for punitive damages in medical malpractice cases, health insurance policies generally do not cover these damages.

Lawsuit Settlements

While health insurance policies may cover the legal costs associated with pursuing a medical malpractice lawsuit, they usually do not cover the settlement or judgment awarded in the case.

Patients may be responsible for paying out of pocket for any damages awarded by the court.

Mental Health Treatment

While health insurance policies usually cover the costs of medical treatment to address the physical consequences of a medical error, they may not cover mental health treatment.

This can include therapy, counseling, or other treatment to address emotional issues that may arise as a result of the medical error.

What to Do?: Navigating Medical Errors

If you suspect that you or a loved one has been the victim of a medical error, there are several steps you can take to navigate this situation:.

Contact Your Healthcare Provider

If you’ve experienced an adverse outcome as a result of a medical error, your first step should be to contact your healthcare provider. This can be your primary care physician, surgeon, or hospital administration.

Explain the situation and ask for an explanation of what happened and what steps will be taken to correct the mistake.

Gather Evidence

If you decide to pursue legal action against the healthcare provider for a medical error, you’ll need to gather evidence to support your case.

This can include medical records, photographs of injuries, witness statements, and other documentation that shows the adverse outcome was the result of the healthcare provider’s negligence or misconduct.

Consult with an Attorney

If you decide to pursue legal action against the healthcare provider, it’s important to consult with an attorney who specializes in medical malpractice cases.

They can help you understand your legal rights and options, and can guide you through the legal process.

File a Claim with Your Insurance Provider

If you’ve experienced an adverse outcome as a result of a medical error, you may be eligible to file a claim with your health insurance provider.

This can help cover the costs associated with additional medical treatment, lost wages, and other expenses related to the medical error.

Conclusion

Medical errors can have a significant impact on a patient’s health and wellbeing, and it’s important to understand what is covered by insurance in these situations.

While health insurance policies generally cover a wide range of medical expenses related to medical errors, there are some costs that are typically not covered. Patients who suspect they’ve been the victim of a medical error should contact their healthcare provider, gather evidence, consult with an attorney, and consider filing a claim with their insurance provider.