Legal Question in Health Care Law in New Jersey

My husband has been going to a pain management doctor for quite some time. They have always accepted our insurance and there was never an out of pocket expense. For some reason the office had told him there was a problem with the insurance and he had to pay $600 for the months of June, July, & August in order to be treated in August. He paid one lump some "cash only". He then proceeded to have two more appointments that were still not covered totaling $1,000. I called the union that receives all the claims to find out why we are paying all this money with no sign of reimbursement only to find out they had not received not one claim (approved or denied) all year. My husband has been going once a month for a good 2-3 years. I did some research and found that as of May 2011 this doctor has had a temporary license suspension & is being further investigated for billing issues. What are my rights? What type of lawyer if any do I need to contact? Thank you for your time.


Asked on 11/07/11, 2:30 pm

1 Answer from Attorneys

Doctors do not have to take insurance. Sounds to me like your doc is going cash only, which means you can send the bills to your insurance and get payment from them. Your option is to go to another doc, but I know it is hard to find pain management docs (docs HATE the scrutiny that goes with proscribing opiate medications, which are the MOST abused drugs in the US). Lots-o-docs lose their license over proscribing opiates. Get invoices from the doc and live with it, and start to look for another doc. One option may be to go to the doc, and demand they continue to see your husband w/o cash payment, because you know they are not billing the insurance company. Doc legally can not change how he operates w/o giving you proper notice, and it is just unfair, but any "threat" against the doc will likely mean he will refuse to see a patient. My brother has been fighting with his insurance company for a year, and in the mean time, we are out of pocket $10,000 so far. --- Good luck!

Read more
Answered on 11/08/11, 7:15 am


Related Questions & Answers

More Health Care Law questions and answers in New Jersey