Outpatient surgery center patient cashed large insurance check and wont pay, what can we do?

Question

I work for an outpatient surgery center. We have a patient that had a very expensive procedure at our facility. We billed the patient's insurance and they paid...the patient. The insurance company says it's our problem to get the money from the patient. The patient won't return calls or mail. What laws has the patient broken? What can we do to convince the patient to repay us?

Answer 1

True, your deal with the patient is one deal, his deal with teh insurance company is a seperate deal.

You'll have to sue him in court, for failure to pay for services rendered. It's a debt, what he owes you. You'll win, then you'll have to try to collect from him. You can attach any assets he has, or any future wages, after you get the judgement. Can't do much without the judgement, except sic a collection agency on him.

Answer 2

If the patient signed an assignment of benefits, you have a legally binding contract by which the patient assigns any payment the insurer makes on the surgery center's charges directly to the surgery center. If the insurer ignored the assigment--this is different than an "authorization to pay directly"--you may be able to take legal action against the insurer to require them to pay you. You'll need an attorney to advise you. While no law has been broken, you can file a civil suit against the patient. Even if you don't have an assignment, the patient has a legal obligation to pay you. Unfortunately, it sounds as though you're going to have to send this to collection against him or file suit in order to discover what financial assets he has and if he's employed so you can garnish his wages. This is going to be an uphill battle, no matter what.

Answer 3

Are you contracted with the insurance company in question? If you are, then check the terms of your contract with them. Most likely, they will have to pay you directly.

If you're not contracted with the insurer, you'll be stuck going after the patient. I used to work for one of the largest insurance companies in my state (Ohio), and we only paid the provider directly when they were contracted with us OR under certain circumstances at patient request. Period. If the provider was non-contracted with us, then the payment would go directly to the patient. (I was told that we did this primarily for 2 reasons...1) b/c the provider wasn't contracted, we had no way of knowing whether they had already collected payment from the patient in advance and 2) a non-contracted provider wasn't obligated to accept our usual and customary rates, so the patient could still be held liable for the difference between our payment and billed charges.)

Some of the non-contracted providers didn't like it, but that's just the way it was. When they called to verify benefits, we'd be very clear with them that payment for services w/non-contracted providers goes directly to the patient. Did you call the insurer directly to verify benefits for the procedure?

Answer 4

It's theft of service, along with larceny.

Report them right to a collection agency - you've made a valiant attempt to get paid, and what this patient did was stole the check - and the service. If that isn't in the cards - get a lawyer and sue the patient.

Answer 5

You have 3 options - 1. A collection agency 2. An attorney or 3. A lien on the assets. Normally, a provider uses a collection agency or an attorney. A collection agency will hit the credit, an attorney will take them to court.

1st step - instead of calling, write a letter (return receipt) that you will be sending their account for a legal alternative if they do not pay by a certain date or if they do not call by a certain date. 2nd step - ACTION

Answer 6

If the patient signed an authorization for you to bill the ins directly, and they paid him by mistake, then they blew it.
If they missed an assignment, ( a directive that orders the ins co to pay the provider direct)the the ins carrier owes you payment, and you have grounds to go to collections against the ins co.,and the fact that the patient was paid by mistake is between the patient and the ins co.
I suggest you take this up with your accountant.

Never expect an ins co to admit they screwed up.

Answer 7

Sue the patient

Answer 8

I would think that is similar to stealing your services....sue her or him to recieve your payments