Legal Question in Insurance Law in Texas

My wife went to her doctor for an annual physical. She filled out the insurance form that the doctor gave her, and clearly stated who our insurance provider is. Nobody at the doctor's office, nor the doctor herself, mentioned to my wife that there was any problem with the insurance. Our insurance provider covers 100% of the cost for annual physicals, so this checkup should have been no cost to us. However, weeks later the doctor sent us a bill for $453 saying that they are not associated with our insurance provider. I believe that the doctor has a legal responsibility to inform patients in advance if services they are going to perform are not covered by the patient's insurance. Since this was not done, I do not think I have an obligation to pay the bill. Is my viewpoint legally correct?


Asked on 1/27/12, 1:24 pm

1 Answer from Attorneys
Mark Dunn Mark D. Dunn

No, you're wrong.

The doctor has no duty to find out if your insurance coverage is good; that's a contract between you and someone else. He performs a service, and charges a fee; he either gets paid by the insurance company, or he gets paid by you.

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Answered on 1/28/12, 4:12 pm


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