Legal Question in Legal Ethics in California
I was told by my doctor's office a surgery was authorized. The insurance company said they never authorized the surgery. Now the doctor's office wants me to pay the bill. The insurance company said the surgery was not medically necessary per their guidelines. What legal obligation do I have?
1 Answer from Attorneys
I had an issue with a client along these lines last year. The problem is, the client signed a paper with the doctor's office stating that they would be responsible in the event insurance did not cover the charges. This means when the doctor's office sues for breach of contract, there is an agreement in writing, with an integration clause, that states that the written agreement is the sum total of the agreement. The parol evidence rule bars admission of oral testimony to dispute the terms of a fully written integrated agreement.
I wouldn't be surprised if you signed a similar agreement. At best, you may have a counterclaim for fraud. In the future, I would verify with your insurer whether something is covered, rather than taking the nice-girl-up-front-who-wears-scrubs word for it.