Legal Question in Health Care Law in California
Is patient responsible for costs above the insurance payout?
I had some procedures done to my teeth. The total cost was $750. My insurance fully covered me, so essentially I had no co-pay for the procedures. According to the Insurance Company, they paid out $250 to the provider according to their provider contract. The Balance is now being charged back to me. I called the doctors office; they said I am obilgated to pay (they've started collections) because I signed a medical waiver which had a payment clause in it. I called the insurance company; they said that they have done their part, and I should not have to pay according to my contract with them. The process has been on going, back and forth. Do I have any chance of fighting these charges?
1 Answer from Attorneys
Re: Is patient responsible for costs above the insurance payout?
Yes. First, you get the copy of the contract between your insurance and the dentist. Upon confirmation that the dentist is pursuing you in violation of the contract, you send a demand to cease and desist via certified letter to both, the collector and the dentist, referring to the contract.
Second, if they refuse to stop, you then file complaints with the dental board and your insurance company, asking your insurance company to assign you an attorney to defend against the illegal collection. If your insurance declines, you file a complaint with the Dept of Insurance. Make sure you get and review your policy. You may have an insurance bad faith action for failure to defend.
Third, you hire a lawyer if the above doesn't work out and after successfully defending you sue them for malicious prosecution, abuse of process, unfair business practices, etc.
Good luck,
Related Questions & Answers
Looking for something else?
10,200 active attorneys ready to answer your legal questions today.
Featured Attorneys
Earn additional revenue and grow your business.
