Legal Question in Insurance Law in California

Procrastinating Doctor

I received treatment from a medical doctor about 1.5 years ago (California). Only recently did they file a claim to my insurance company. Naturally, the insurance company rejected their claim of $150 because the plan says that providers must submit claims within 90 days. Now, the doctor is charging me for this amount. Do I have a legal right to reject this charge?


Asked on 5/31/07, 8:43 pm

2 Answers from Attorneys
Robert F. Cohen Law Office of Robert F. Cohen

Re: Procrastinating Doctor

Yes. You're a third-party beneficiary of the agreement between the insurance company and the doctor. The doctor agreed that he'd be paid by the insurance company if he made a timely claim. Write to the insurance company (or call) and see if they can help resolve this issue with the doctor, somehow.

Read more
Answered on 6/06/07, 2:59 pm
Jonathan Stein Law Offices of Jonathan G. Stein

Re: Procrastinating Doctor

Yes, but you need to read your policy. Generally, the doctor has agreed to accept whatever the insurance pays. If it pays nothing because of his error, he gets nothing. But, each policy is different so you need to read your policy carefully.

Read more
Answered on 6/06/07, 3:20 pm


Related Questions & Answers

More Insurance Law questions and answers in California