Legal Question in Credit and Debt Law in California
Sued for payment of medical test
Doctor requested I have a test performed in the office. The doctor is a PPO provider under my spouse's insurance (I am a dependent) and all my financial transactions and co-pays are conducted through the doctor's office regardless of what tests are performed there. I was sued by the person who administered the test claiming they are an out of network provider. I was never informed by either party that this test was being performed by an out of network provider, nor did I agree to such terms. I did not provide the plaintiff with my insurance information. The plaintiff filed with the insurance company and a check was sent to the subscriber (my spouse) for a lesser amount than I am being sued for. Since I did not enter into a contractual agreement with the plaintiff what is my liability? Is the plaintiff entitled to the insurance check received by a third party and is it my responsibility to collect from the third party for the plaintiff? Is it a violation for the doctor to have provided my insurance information without my consent to the plaintiff who claims they are not in the doctor's PPO plan? The doctor requested the services from the plaintiff so is the doctor responsible for paying plaintiff?
1 Answer from Attorneys
Re: Sued for payment of medical test
Since I did not enter into a contractural agreement with the Plaintiff, what is my Liability? Your liability to the plaintiff is the value of the services provided.
Is Plaintiff entitled to the insurance check received by a third party and is it my responsibility to collect from the third party for the Plaintiff?
Yes, Plaintiff is entitled to the insurance check. No, it is not your "responsibility" to collect from the "third party" who happens to be your wife. You have a right to collect the money you are required to pay the plaintiff from your wife, but you do not have to if you don't want to.
Is it a violation of the doctor to have provided my insurance information...? Probably not. You may have a right to privacy regarding personal medical information, but I know of no right to privacy pertaining to insurance information.
Is the doctor responsible for paying the plaintiff? Yes, but if he does, he can sue you for reimbursement.
I am curious why you have no concern about the insurance company underpaying you? That is the question you should be asking.
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