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  1. #1
    Join Date
    Feb 2014
    Posts
    11

    Default 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?

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default 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.

  3. #3
    Join Date
    Feb 2014
    Posts
    11

    Default 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.

  4. #4
    Join Date
    Jan 2006
    Posts
    38,867

    Default Re: Medical Service Provider Threaten to Sue Me for Theft of Services

    Quote Quoting duckwing
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    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.

  5. #5
    Join Date
    Jun 2010
    Posts
    179

    Default 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?

  6. #6
    Join Date
    Jan 2006
    Posts
    38,867

    Default Re: Medical Service Provider Threaten to Sue Me for Theft of Services

    Quote Quoting mihamih
    View Post
    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.

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