Legal Question in Insurance Law in Florida

Insurance Payment Withdrawal

I've seen this question, in part, before, but here it is again. If an insurance company approves a medical procedure, migraine headache shots, and the shots are given. This occurs 3 times over 6 months. The insurance paid for all three, then, after the shots were given, the insurance decided it should not have approved the shots and takes back the money. The doctor says that I am responsible for payment of the shots ($1,600). If I want to fight this, what court do I take it to and who do I take to court? Is this small claims? Do I take both the doctor and the insurance company? Since it is under $5,000, neither party can have a lawyer, correct? I do not think I am responsible for the shots, because if the insurance company would have refused in the first place, we would not have gotten the shots and tried something else.


Asked on 2/05/08, 6:14 pm

1 Answer from Attorneys
Alan Wagner Wagner, McLaughlin & Whittemore P.A.

Re: Insurance Payment Withdrawal

The answer depends on what kind of insurance you have. If you have private insurance, you have better rights. If you have insurance provided through your employer, almost always a federal law known as ERISA applies. That law overwhelmingly favors the insurance company and you may very well lose.

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As for you doctor, almost certainly you signed something that essentially says that if your insurance company does not pay, then you are responsible. If you are "stuck" with the bill, they may reduce it some.

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Answered on 2/05/08, 9:13 pm


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