Is this really true?

Question

my cousin was injured on the job. & needs med attn. on the day of his doc's appt. the doc says the company insurance ppl is "pending" their approve of the said appointment. the doc told my cuz that if the approval isn't made, he'd have to foot the bill himself . in the end my cuz didn't get examed by the doc b/c he was scared he'd have to pay out his own pocket
could the doc really charge the bill to my cousin??
why would they make the appt if payment wasn't already approved by the insurance company?
my cousin's lawyer said he should have agreed to be examed


what gives??

the tests are REALLY expensive

Answer 1

I don't know the rules about workman's comp - which this probably falls under. But, what should've happened is the doctor's office should've had the patient sign a waiver that if the insurance doesn't approve it, he's responsible to either pay it or fight it out with the insurance - because that's how it works for regular insurance companies, a doctor has EVERY RIGHT to make the patient responsible for payment if the insurance isn't vaild or proper and complete info is not provided. You don't work for free, do you? Why should a doctor and his staff?

Answer 2

Yes, if the company defaults on the payment, they would come after your cuz for the payment. To avoid this though, he should have given the employer's address as the responsible party for billing. He should not give any of his personal information. Also the company could get in trouble for not carrying workman's compensation. He should contact the better business bureau. Finally, he should get to a doctor right away. The "pending" insurance will probably cover him, but not if he waits too long. If it is several days past the day of the injury, the insurance company will think he is scaming them and deny his claim.

Answer 3

The doctor was covering his own butt. They want to get paid not matter what, which makes sense, and there are times when a company will contest the injury. And so the doctor was just laying the cards out on the table saying IF they don't pay your cousin would have to. If your cousin has a legitimate injury - which i am sure he does - then the company insurance HAS to pay for it. He should have had the tests done because even if the company insurance decided to fight it, your cousin would have a good court case and still would not have ended up paying the bill.
Have him call the insurance company himself and explain what happened and have them set up an appointment for him to see a doctor ASAP!!!! if they fight him tell him to get lawyer.
Good luck

Answer 4

That's the wonderful world of medical insurance, my friend. All medical plans have a named primary care provider, and just about everything that isn't a routine examination or office visit has to be approved by the insurance company. Since most doctors want to be sure they'll get paid, they can deny service or make the patient agree to pay for treatment if the insurance doesn't approve the treatment/test/procedure/whatever. So technically yes, your cousin could have had to pay out of his own pocket, but since he was injured on the job he should be covered by Workman's Compensation as long as he wasn't being negligent or careless when he was injured. Tell your cousin to lean on his employer to take care of it -- since it happened while he was on the job, it's really their responsibility.

Answer 5

Because the doctor can not refuse treatment to a patient, that is why he made the appointment for your cousin. And if the insurance did not throught he is liable for the payment. Your cousin should have gone to the doctor and did the tests. Every company carries workman's comp insurance, which is used when workers get injured on the job. The insurance eventually would have covered that- as long as it was trully work related injury.

Answer 6

It depends on how long he waited to seek medical attention. If he was injured on the job (and his employer knew about it) the company should have insisted a doctor examine him.

If he was injured and told no one about it until much later then he's got a problem. The insurance company will assume he injured himself outside of work and is just trying to get the company to pay for it.

Answer 7

Of course the doctor can charge your cousin. The issue here is between your cousin and the employer, not the cousin and the doctor. The doctor is an uninvolved third party who is simply trying to make sure he gets paid.

Your cousin needs to speak to his lawyer and regardless of who pays, he needs to have those tests done ASAP. Without them he has no proof or recourse against his employer.

Answer 8

i don't no what state u r n but in Fla the answer is yes. if u c a Dr without ins. approval they will charge u. they make appoints based on expected approval. this is not their responsibility. it is up 2 your cuz to be sure it is approved. i wouldn't have just given up, i would have changed the appt to a later date, to give the ins co time 2 make up their minds.i learned 2 ALWAYS call the ins co 1st and c if they will approve it.

Answer 9

workers compensation...every buisness has this insurance


Workers' compensation systems (colloquially known as workers' comp in North American English or compo in Australian English) provides compensation for employees who are injured in the course of employment. While schemes differ between jurisdictions, provision can be made for weekly payments in lieu of wages, compensation for economic loss (past and future), reimbursement or payment of medical and like expenses, general damages for pain and suffering and benefits payable to the dependents of workers killed during employment.

These laws are usually a feature of highly developed industrial societies, implemented after long and hard fought struggles by trade unions. Supporters of such schemes believe they improve working conditions and provide an economic safety net for employees. Conversely, these schemes are often criticised for removing or restricting workers' common law rights in order to reduce governments' or insurance companies' financial liability.

Employees' compensation laws were first enacted in Europe and Oceania, with the United States following shortly thereafter. Workers' compensation programs were a key component of the labor structure of the former Soviet Union and similar societies.

Answer 10

They make you sign a paper saying that if insurance doesn't pay you will be responsible for payment. So, if they denied the claim, because say for instance a drug test came up positive or something like that, he would be responsible for the bill.