Can a Doctor Bill You Directly for Medical Care Instead of Billing Your Insurance
My question involves dr lying about not accepting my insurance at a surgical center he is part owner in as well, once he found out he couldn't bill my lawyers (lawsuit-letter of protection) 100% for all services done by himself and other drs, operating room, nurses, recovery, car services, anesthesia, etc.
The center definitely takes my insurance I new the day I went there and I called back after they gave me this bs story. He's looking to charge me up to $550,000 over the next year and a half of procedures and if I wasn't smart enough and was so desperate for his services and agreed to let him use the letter of protection he would have charged that full amount to me while letting all of his other patients use insurance.
My current lawyer understand I'm angry but need to focus on the case at hand. I think this is the scummiest thing I've ever seen a dr try to pull. We aren't talking pennies. I want him to get in trouble. I see him in two days to discharge from his practice. They refuse to put the reason in writing and I haven't pushed it because I don't want them to know I know what's going on.
Someone please help. I'm afraid once I walk out that door on Thursday I have no proof of any of this. It was said to me by the receptionist over the phone. Legal suggestion. What can I get from these people. I meet with the dr on Thursday and will also see receptionist. Thank you.
Re: Greed Beyond Acceptable
A letter of protection does not prevent a doctor from billing you nor does it affect the amount they can bill. In no case is the attorney billed anyway. The debt remains the obligation of the patient
a doctor cannot prevent you from using your insurance. At most they can refuse to bill your insurance. That does not prevent you from filing the claim yourself. If the insurance is a ppo or hmo and a signatory provider under your policy, they are contractually obligated to bill through the insurance company.
I dont know what is happening in your situation but so far I don't see you being able to get anything from those people.
Re: Greed Beyond Acceptable
They tried to bill 100% to attorneys (me). For all future visits and when I gave them my insurance card and ID at the surgical center the girl looked at the form, saw the attorney info provided by my drs office and handed it back to me and said she didn't need it. I knew immediately what they were planning on doing. I called the para-legal and told her and said she needed to make it clear to them again that they have to bill my insurance first and the letter of pro is for remaining balances. They weren't happy and said our anesthesiologist doesn't take that insurance. They were given two options. The day I was to go for my appointment, a few days later I get a call from the office manager all sweet and she's not sweet...saying they have this situation and they don't know what to do. The surgical center does not take my insurance and since they can't submit full bills towards letter of protection...
I knew she was outright lying and they were mad they couldn't make a fortune off of my lawsuit. I said just a little about how the girl took my card to copy it then realized she didn't need it. Then is said just discontinue me as a patient and comply legally. Set up my last appt. I then phoned the surgical center and said I was thinking about working with another dr there and needed to find out about what insurances they take and how it works. They confirmed they take my insurance, they do all the billing and I'm responsible for the 20% copay. Does this make things clearer. Now can you try to spread the word and get me some answers on what I need from them if the won't write that's the reason they're discharging me. They're putting no reason at all.
Re: Greed Beyond Acceptable
They don't generally have to have a reason for not wanting you as a patient anymore.
Your posts have a been a jumble of different things so it's impossible for us to figure out what the heck is going on. Further, you have not identified the state this is occurring in so that we could comment on any state specific things.
Re: Greed Beyond Acceptable
why do you have an attorney and why do they even have his information? Is this medical care some type of settlement for a different type of claim than medical? If so, it is possible that your health insurance will NOT pay even if this is a place that would normally take your insurance. There is something called Subrogation. You can't profit by getting your health insurance to pay medical claims due to another reason (say a car accident, etc) that is responsible for paying those claims. Makes no difference if the doctor accepts your personal health insurance or not.
And if you are making it unbearable for the doctor office to do their job and are not understanding, it is their right to refuse to do further work....especially if they are not currently getting paid (hard to tell).
What does your attorney say you should do? (But honestly if it is an ambulance chaser they are going to want your health insurance to pay as much as they can before the settlement money kicks in because of their % of settlement may be after medical bills?? Just guessing)
Re: Greed Beyond Acceptable
If your insurance is a ppo or hmo you need to contact your insurance provider and report the facility. The doctor and insurance company has a contractual relationship which requires them to bill to the insurance company before seeking payment from the patient.
Re: Greed Beyond Acceptable
Quote:
Quoting
jk
If your insurance is a ppo or hmo you need to contact your insurance provider and report the facility. The doctor and insurance company has a contractual relationship which requires them to bill to the insurance company before seeking payment from the patient.
Assuming, of course, that the doctor is a preferred/participating provider with the insurance company, of course. If the doctor has not signed on to be a participating or preferred provider then he or she has not signed anything with the insurance company and won’t be obligated to bill the insurance first.
Re: Greed Beyond Acceptable
Thank you. That's what I thought.
Re: Greed Beyond Acceptable
It does not, however, exempt you from paying whatever portion of the bill you might be responsible for under the contract.