DeFede

MIAMI (CBS4) ― Alice Taheri suffered years of constant back pain.

"The pain that I was in was enough that I would have paid any amount necessary to take care of myself," she said.

And pay she did. Taheri went to the Rosomoff Comprehensive Pain Center for a specialized treatment she was told would bring her relief.

In April 2008 she first went to the center, which is part of Miami Jewish Home and Hospital. Immediately she was told the center would not accept her insurance, Humana.

"I said I really don't want to do this but if you are telling me I have to, then I will," she recalled. "And there was a witness in there at the time saying the only way we will take you is if you do this."

Taheri has no complaint about the care she received at the center, which ended up costing her more than $25,000. But she couldn't understand why her insurance wouldn't cover the treatment. So after months of insisting, she finally received a copy of her bills and submitted them to Humana.

A few weeks later she received an Explanation of Benefits letter from Humana telling her that she was in fact covered. Furthermore, based on the agreement between Humana and Miami Jewish Home and Hospital, the insurance carrier was willing to pay $8,533 for the treatment and anything more than that would be absorbed by the hospital.

In other words, the most she should have been charged was slightly more than $8,500 and that would have been covered by Humana.

"When I see this and I get this in the mail, I go through the roof," she said, holding the letter from Humana. "This is a lot of money, this is a lot of hard earned money, plus the fact that they deceived me. More so than anything else they were playing games with me."

She contacted the hospital demanding a refund. The hospital refused saying the pain center is not covered under the agreement between the hospital and Humana.

Taheri is now suing the hospital and her attorneys believe "hundreds" of others may have been misled about the acceptability of their insurance.

"In my opinion this is nothing more than greed and exploitation of ignorant and uneducated customers and clients," said Ron Lauzim, an attorney representing Taheri. "When you are a self pay or private pay you are going to have to pay retail and pay 100 percent of what the cost is. Whereas if they have to process the claim through their insurance company contract they are going to have to accept the discounted amounts."

"This is a colossal breach of trust not only to Alice but to all of the patients," said David Charlip, another of Taheri's attorneys.

They filed a lawsuit last week in Miami Dade County Circuit Court seeking not only the money Taheri pad the hospital but they are also seeking to find the names of all of the other patients whose insurance may have been denied for a possible class action lawsuit against the hospital.

"We've been told that hundreds of people have been turned away, somewhere in the neighborhood of 40 or 50 people have been charged sums in excess of what would be proper under the pre-negotiated insurance contracts," said Charlip. "And if we go back a number of years there is no telling how many people it would add up to."

In a statement, Miami Jewish Home and Hospital issued a statement saying: "The Rosomoff Comprehensive Pain Center recognizes that providing the highest level of patient care bears significant costs. For this reason, the Rosomoff Pain Center has contractual relationships with several insurance providers. In fact 94 percent of Rosomoff Pain Center patients access their care through an insurance plan or through Medicare. Unfortunately, the Pain Center program is not a covered service under Ms. Taheri's insurance carrier."

The statement goes on to say: "Ms Taheri was advised before beginning the program that Rosomoff did not participate in the carrier network for her insurance provider. Upon acknowledging this fact in writing, Ms Taheri chose to self-pay for her treatment."

Taheri's attorneys claim there is no difference between the pain center and the hospital. The pain center is located within the hospital and they share the same tax ID number. Any agreement Miami Jewish Hospital has with Humana applies to the pain center.

All of Taheri's bills came from Miami Jewish Hospital, they note, and the checks she wrote to pay those bills were deposited in Miami Jewish Hospital's bank accounts.

Humana must agree they were liable, the attorneys argue, because they were willing to pay for the treatment. Citing privacy laws, Humana would not comment directly on Taheri's insurance plan.

The CBS4 I-Team obtained a copy of a sworn statement from a former employee in the billing department of Miami Jewish Home and Hospital, who said there was no difference financially between the Rosomoff Pain Center and Miami Jewish Home and Hospital.

"The pain center is a part of Miami Jewish Home and Hospital," said the former employee, who requested anonymity. "They are not separate."

The employee said Miami Jewish did not want to take certain insurance policies because they would not be paid enough money under the plan.

"Well, basically if the patient came in with insurance such as Humana where they would contract as a very low rate, we did not want to accept that contract because of the fact that they wouldn't be paid enough money," the former employee said. "So we would have the patient start paying and said we did not accept their insurance."

Asked specifically about Taheri, the former employee said: "Technically they should have accepted the Humana but as I said before, with the amount Humana would have paid us they didn't want to accept it."

Taheri, a former substitute school teacher in Broward County, said the hospital was counting on her to just pay for her treatment and not question it. But, she said, it is in her nature to fight when she believes she is being mistreated.

"I don't like to be abused and treated that way," she said. "They treated me like a clown and I'm not a clown."

(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)

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