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My word against the doctor?


CarolynintheCity
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I had an accident at work about 3 years ago.

I was treated by several doctors and physical therapists. Workers comp and my primary insurance paid all the bills. Almost a year later I started to get a stiffness in my neck and my dr suggested a chiropracter. I went to one near where I live. They took my history and assured me that the bills would all be paid by my insurances. It was not a dire need to have this work done and I never would have had it done if it wasn't covered.

I had adjustments and treatments 3 x a week for 2 months even though I felt better after the first week. I didn't think I needed that many. For the last month I kept telling the dr I felt fine and he kept adding more and more things to my treatment (hot treatments, massage) to "be sure". He kept saying better safe than sorry...don't worry, the insurance is covering this. I finally ended the treatment even though they kept wanting me to come back I felt no need for it. I thought I was fine and have never had any more problems.

I started to receive bills a few months later because the workers comp said it wasn't covered (too long after the accident) and the doctor's office assured me they were going to my primary insurance. I never thought of it. They had 12 months to send the bills to my primary insurance. Almost 14 months later I receive a bill from a collection agency telling me that I owe this money (almost 2000.00). They never submitted the bills to my primary insurance stating that I wasn't covered for their services through my primary insurance. They are not an in-network provider and my insurance wouldn't cover it. According to them they didn't submit bills, just "called" the insurance who told them that. This is news to me.

The doctor's billing person is also his wife, which I found out inadvertently from my insurance company (they don't use the same last name).

When I disputed the bill with the CA, she (dr's wife) stated to the CA that I was informed that I would be responsible and insurance wouldn't cover this. That is EXACTLY the opposite of what I was told. I would have never had all these treatments if I thought it wasn't covered. They were not necessary and, in the end, I really thought I was being brought back for no reason. I was the one who ended it, they would have had me there forever. They are now saying that even if I had insurance they are under no obligation to submit. If I did not have insurance I would not have had these treatments.

I don't know what to do. It seems to be my word against theirs. Any suggestions?

I'm in New York

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DV the CA and ask for a signed agreement. The DR should have had you sign a billing agreement that states you are responsible if the insurance doesn't pay. If they do not have one, they cannot legally report. If they do have it, you are stuck having to pay.

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I realize this isn’t what you want to hear but the bottom line is, the patient receiving the services is responsible for paying for those services regardless of whether insurance is involved or not.

Yes it was pretty scummy for the Doctor’s staff (wife or otherwise) to assure you that insurance would pay the bill but frankly, that should have been a big red flag – no competent Doctor’s office is going to make such a claim because NO ONE can guarantee that insurance will cover anything. And as has already been pointed out, I suspect you signed a document saying that you are responsible for whatever charges are not covered by insurance. That aside, when it comes to matters of law, which is what we are really talking about here, if it isn’t in writing it didn’t happen…what was “said” is meaningless.

Also, in today’s health-care world, you don’t just go to a Doctor and assume your insurance is going to cover it (unless it’s a life threatening issue)…you should have contacted your insurance provider and gotten their Ok or a list of providers who is in their network before you ever saw anyone.

Now, it does sound as if there are some mitigating circumstances such as being misled by the Doctor’s office and their failure to bill your insurance provider properly - so, I would say you have a basis to negotiate an amount you can live with but I think you are going to have to settle it because based on the information you’ve provided, you do legally owe it whether it seems fair or not.

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