Medical Service Provider Threatens to Sue Me for Theft of Services
My question involves criminal law for the state of: New Jersey
My daughter used 2 months of services for and her bill has been paid for by my health insurance company. Just before her services ended, the service provider dropped off the network and the payment checks came to me. I cashed them but the service provider never bill me or have any communication with me about it. The first time they contacted me was back in November/December, which they charged my credit card without my authorization. I have the charge disputed.
Fast forward to today, they email me about it, so I said I am going to pay them if they send me the bill. They refused to sent me a bill. So I called up my insurance company to find out how much I have received and so I made an offer to them for the amount. The amount is $2,472.06 and I told them I can mail it out today to resolve the issue. They refused. Instead, they generated an invoice today for $6,800 for a service with published rate of $2,160. The owner said if I don't pay by today, she will sue me for Theft of Services.
What is my option here?
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
If the services were incurred while they were still a member of your health insurance network, then you contact your health insurance carrier and have them handle it.
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
I did contacted my health insurance network, but they said they cannot not do anything because the provider was dropped off network during the services. I was never notify by the provider that they were drop off the network.
My concern is about the theft of services. Do they have ground on it? I never refuse to pay or avoid paying.
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
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duckwing
I did contacted my health insurance network, but they said they cannot not do anything because the provider was dropped off network during the services. I was never notify by the provider that they were drop off the network.
My concern is about the theft of services. Do they have ground on it? I never refuse to pay or avoid paying.
I don't know about theft of services but there is a bit of insurance fraud or actual theft in the picture. The insurance company sent you money which was owed to the provider. You put it in your pocket.
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
I don't know that I'd call it theft/insurance fraud. She was waiting for a bill from the provider. I've been in a situation like this. I practically had to ask provider to send me a bill for what my insurance paid me. Yeah she could have been more pro-active but still. She did offer the money the insurance paid right away...
What is this with the published rate? Where do you get this number? Is this price that provider advertised? Discount rate negotiated by your insurance carrier? What exactly?
When you first contacted provider, did they advertise/say that they accept your insurance?
Are you basically saying that they billed you for $6800 but insurance only covered $2,472.06. What was the reason they only covered 2K? Discounts? Out of network? What? Isn't there an EOB? What does it say?
Have they received any money from insurance already before being dropped? Or is the 6800 for all services they ever provided to you?
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
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mihamih
I don't know that I'd call it theft/insurance fraud. She was waiting for a bill from the provider. I've been in a situation like this. I practically had to ask provider to send me a bill for what my insurance paid me. Yeah she could have been more pro-active but still. She did offer the money the insurance paid right away...
no, she didn't. several months have passed since receiving the payments. That is surely not "right away" and they only offered to send the insurance payments if it was considered paid in full. That is not sending the money right away.
Simply stated; OP had no right to retain the insurance payments, ever and in doing do, deprived the provider of payments made by the insurance company intending to be paid to the provider.
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
What I did was what need to be done. I spoke to the my insurance company and this is what they told me. The provider need to bill me, which they never did.
The published rate is what is listed on the application. There was 8 weeks of services and if you pay in cash it is $13,500. However, the agreement was if I use my insurance company and the insurance company pay them 70% of what they bill, there will be no out of packet cash for us. That's what we did. The cash rate is about 300 to 360 per day if you break it down by day. However, they billed the insurance $850/day and received $595 (70%) of it.
Before they dropped off the network, they have received $17076.25
The $2,160 I mentioned earlier is from $1800 week no multi-weeks discount plus 1 days $360 ($1800/5).
I was offered to sent the payment before they issue me an invoice. Like I said, they refused and created a $6800 invoice instead.
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
What does any of that have to do with you keeping the money from the insurance company intended for the provider? Did you think you got paid for sending your daughter their for treatment.
When did you discover they no longer were "in network" and did your daughter continue to recieve treatment after that point?
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
I have only found out yesterday after I called my insurance company to find out why suddenly the check came to me.
I never intend to keep the money.
Re: Medical Service Provider Threaten to Sue Me for Theft of Services
If your agreement clearly states $13,500 and they've already received $17,076.25, what the hell do they want..... It is not your fault they got dropped out of the insurance. What you owe them from the date they dropped till the date the service ended is somewhat subjective and would depend on the ruling judge. However, if I were the ruling judge it will be the "cash daily rate" defined as cash price / number of services. You say that number is between 300 and 360. You have to calculate exact number. It's not a relative number.... In court they will want exact numbers. So what you would owe them is what you calculate with the reservation that you must figure the exact amount. That insurance money that came to you. I take it this is for that period of time after they got dropped (1 week + 1 day). If not, you need to give that to the provider + the cash for 1 week + 1 day. Since they were dropped and the number is now different, you need to call insurance and let them know once this is all resolved and ask what they want you to do about the extra money.
Can the owner of the business charge you with a crime? No. No civilian can charge another person with a crime. The police, state, or federal government can charge you with a crime. She can report it to local police and they can choose to investigate and then potentially charge you. But I see nothing to charge you with. I guess jk disagrees so take my opinion with a grain of salt. She can, however, sue you in civil court if she really feels that she was wronged in any way. Does not mean she will win but she can sue you.
Now if this happened to me, I'd first do some due diligence on that vendor. See if your county has an online web site that shows all civil suits. Then search business name and owner name. Check if anyone has sued them or if they have sued anyone. And check how these cases turned out. Also go to secretary of state and see if you can see how long they've been in business. This should give you a good idea of what/who you are up against. But my guess is you are up against a low and cheesy business that won't stay afloat much longer. Then I'd probably write them a letter explaining that they got paid 70% from insurance which is higher than the daily cash rate till the day the got dropped out. I would also include a check for the daily cash rate * days you received service from the date they dropped out till the service ended and tell them I have included what I owe them per the cash agreement since they could no longer collect from my insurance. Keep a copy of the check if they don't cash it so that you can show the court that you offered to pay them what was reasonable. But I'll be darned if I just write a check to some business just because they threatened to sue me....
I hope this helps!