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Clinic did not check my eligibility for med. insurance and charging me for it

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by Jshin87, Mar 23, 2010.

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  1. Jshin87

    Jshin87 Law Topic Starter New Member

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    I went to a clinic to get an X-ray for my hand which i injured, and at first they couldn't find my medical insurance information. I then called Healthnet and had them fax over my medical insurance papers to the clinic at which point, they said they would accept it. I took my X-ray and left after they said I was finished, assuming that my medical insurance was accepted. I then received a call 3 days later saying they could not accept my insurance, and I have a balance of 130 with them when my insurance should have covered that. It was their responsibility to check and see if my insurance was accepted before sending me in for an X-ray which they did not do. Who should be liable for this?
     
  2. cbg

    cbg Super Moderator

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    Where are you getting the idea that it is the clinic's responsibility to check your medical insurance? Unless your policy SPECIFICALLY says otherwise, it is YOUR responsibility, not the provider's, to confirm what providers and what treatments are covered.
     
  3. Jshin87

    Jshin87 Law Topic Starter New Member

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    The medical insurance provided a clinic for me to go to for all my medical needs, and the clinic couldn't find my insurance eligibility, and i had to call health net to verify with the clinic. After this, the clinic said they accept my insurance which is a PPO when they told me later, they don't accept the ppo and they admitted to their mistake. Does that answer the question?
     
  4. army judge

    army judge Super Moderator

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    No, although you may believe otherwise, it is your responsibility to pay your medical bills.

    All you have is what you heard, none of it in writing, which won't get too far in court.

    If you have a beef, it might be with your insurer.

    The clinic does not have take any health insurance.

    They aren't required, YET, to provide a service today and get paid in the future.

    It might be what some call, unfair, but it isn't illegal!


    Sent from my iPhone using Tapatalk
     
  5. cbg

    cbg Super Moderator

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    Does the policy say, in so many words, "It is the responsibility of the provider to confirm insurance eligibility"?

    If it does not, then it is your responsibility and you are responsible for the bill, regardless of who made the mistake.
     
  6. Jshin87

    Jshin87 Law Topic Starter New Member

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    cbg are you a lawyer? if not then please refrain from posting on this thread as your information would be useless otherwise
     
  7. cbg

    cbg Super Moderator

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    When you post on a public board, you do not get to control who answers.

    I have 30 years direct experience with health insurance plans; is that good enough for you?
     
  8. Jshin87

    Jshin87 Law Topic Starter New Member

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    hmm not really no.
     
  9. cbg

    cbg Super Moderator

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    Well, that's too bad, because I've given you the correct legal answer. It is NOT the responsibility of the provider to check your insurance unless your policy SPECIFICALLY says it is.

    I can tell you what your recourse is if your policy DOES specifically say that too. Are you sure you don't want me to answer?
     
  10. Jshin87

    Jshin87 Law Topic Starter New Member

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    yes I'm pretty sure
     
  11. cbg

    cbg Super Moderator

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    Well, that's too bad, because I'm going to tell you anyway.

    If your policy does have language making it the responsiblity of the provider, you contact your insurance carrier. They will have a department called Provider Relations, or something along that line. The Provider Relations department will be able to assist you - they will notify the provider on your behalf that you are not responsible for the bill and they will take whatever action against the provider that is necessary.

    If you are unclear as to whether you are liable for the bill or not, contact Provider Relations - they will also be able to tell you whether you have any liablity to pay the provider or not.

    Now, if you choose to disregard me because you are not satisfied with my qualifications, you are free to see if a tax attorney or real estate attorney can give you an answer you like better than mine. After all, they are "real attorneys" even though they don't work directly with this, and I do.

    Did I mention that there are a couple of attorneys, and one judge, who call me to ask how to manage their staff benefit issues?

    Oh, that's right. You don't want to hear what I have to say.
     
  12. Jshin87

    Jshin87 Law Topic Starter New Member

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    WOW really?! you have a couple of attorneys and a 1 judge who call on you to help them manage their staff issues?! MAN! I think you deserve a cookie!
     
  13. Jshin87

    Jshin87 Law Topic Starter New Member

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    Did I mention you deserve a cookie??
     
  14. cbg

    cbg Super Moderator

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    Why, thank you. If you have cookies, I'd be delighted to have one.

    As I said, if you want to contact a "real lawyer" rather than someone who works with the issue every day of her working life, that's your call. Feel free to pay an attorney $250-$300 to get the same answer.
     
  15. Jshin87

    Jshin87 Law Topic Starter New Member

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    You should ask the judge and the couple of lawyers that call on you for a cookie. As for paying 250-300 to get the same answer? you do realize there are lawyers who give free consultations right? wow for someone who has been doing this for 30 years and not think of that? kinda makes me wonder just how "qualified" you really are but nice try.
     
  16. cbg

    cbg Super Moderator

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    And here I though you were offering me a cookie. I'm so disappointed.:dgrin

    I'm aware that many attorneys give free consultations, particularly in the field of personal injury. But this is not a personal injury case.
     
  17. Jshin87

    Jshin87 Law Topic Starter New Member

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    Personal injuries is not the only case where lawyers give free consultation, just so you know. Also, considering you have "lawyers" and a "judge" calling on you for help, you sure do have alot of time going back and forth on a forum.
     
  18. cbg

    cbg Super Moderator

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    Have a nice day.
     

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