My OB/GYN sent me a bill after our son was delivered for "out-of-network" charges. All along we thought he was in our network and he never told me otherwise. We later found out he dropped our network a month before delivery. I'm being hounded by a collections agency, but I don't think I should pay. State laws don't help since our health plan is "ERISA," or a national health plan. To make matters worse, my doctor has quit the business and is no longer a practicing physician. Can I still sue him in the small claims court to stop him from charging me?
2007-04-26 05:02:15 · 4 answers · asked by Roger Y 1 in Business & Finance ➔ Insurance
I would think that this would be your responsiblilty and not your doctors, I think that you will have a hard time winning this case but you would need to talk to an attorney about it to see what they think, I hate insurance and the way that it works it always screws the ones that need it and the ones that could afford to pay the doctor bills out of pocket always get what ever they want.
2007-04-26 05:08:36 · answer #1 · answered by Randysgirl 2 · 0⤊ 1⤋
No, because as a patient it is your responsibility to know (or to find out) who is in your network BEFORE services are rendered. It would have been a courtesy for his office to inform you, but it's not required.
If you try to sue him, you'll more than likely lose because you did recieve those services - and if you don't pay, you'll get sued for the same reason. The doctor is entitled to be paid for services he performed. It doesn't matter that you don't agree with the amount.
You can try calling your insurance and asking them to reconsider the charges because for 8 months the doctor was in-network, so this should fall under what's called "Continuity of Care". Otherwise, you're going to have to pay unless you want to get sued or at the very least have your credit in the dumper. If you have to pay, offer him half and see what he says - if he sends you to a collection agency, that's what he'd get anyway. (and that's about the amount the insurance would pay anyway.)
2007-04-26 12:59:24 · answer #2 · answered by zippythejessi 7 · 0⤊ 0⤋
No, it's up to you to verify whether or not he's in network, ultimately, not him to let you know.
If you don't pay the bill, he's going to sue YOU in small claims court, and win. Small claims court isn't for "cease and desist" type suits - you'll have to file a civil suit for that (and pay for the lawyer out of pocket, and you're going to lose).
You're better off trying to appeal the decision to your insurer - reminding them that the bill includes not just the labor & delivery, but all your prenatal care as well, and for the majority of the service period he WAS in network, and they should reimburse based on that. Additionally, if the baby was delivered at an "in network" hospital, they should consider the hospital ob that delivered him "in network" as well.
2007-04-26 12:44:27 · answer #3 · answered by Anonymous 7 · 0⤊ 0⤋
Probably not. The service he's billing you for was performed. The paperwork you signed in the doctor's office probably stated you would be responsible for balances left unpaid by your insurance company. Legally, he has every right to bill you.
You can send an appeal to your insurance company. Even if they're self funded, and Erisa mandated... They still have to process & consider the appeal. Good luck
2007-04-26 20:59:45 · answer #4 · answered by Custo 4 · 0⤊ 0⤋