Medical collection validation

You may have to sue. Search the archives for discussion on this subject.

-Cliff

 

#2 If the OC fails to bill your In.s Co. that does not mean the whole amount is the amount not covered by the Ins. Co. You may be liable for Deuctables, Co-Pays and amounts that EXCEED what is called the Usual and Custmoary Charge. It should say in your contract what heppens if an MP fails to properly bill.

You should call your Ins. Co. in the morning and find out if they received this claim and when. Ask them for a letter explaining the specifics, whether they got the bill or not.

http://consumers.creditnet.com/stra...threadid=27620&perpage=20&pgnum=&pagenumber=1

 

Also, check the account number on the statement from the doc that says no insurance. I used to work for a doctor and sometimes a person gets an account made twice (i.e., couldn't find them in the system, so just made a new one). So, perhaps they screwed up and used the wrong patient account.

Just a thought.

 

Implied consent is a legal term indicating your acceptance of a contract through your behavior, rather than your signed or verbal consent. The classic example of implied consent is: a man walks into a barber shop and takes a seat in the barber's chair. The Barber believing the man wants a hair cut begins to cut the man's hair. When the barber is finished, the man refuses to pay stating that he never asked for a hair cut and never agreed to pay for one. In this case, the courts would rule that the man implicitly agreed to the contract for a haircut by his behavior, ie going into the babrber shop and sitting down in the chair, and allowing the barber to cut his hair. The courts would rule that the man is legally obligated to pay the fair market value of the services he received, regardless of the presense of a written or verbal agreement between the parties. This is what the doctor's office means by implied consent. If you can prove that the services you received were not worth what the Doctor is charging, based on a fair market evaluation, then you have a valid dispute. If you never received services from the doctor then you never had any contract, implicit or explicit.

 

This may help. My insurance has a policy that they will not pay if a bill is not submitted within a certain number of days by the doctor. The doctor agrees that if he screws up by failing to submit the bill on time, he cannot bill the patient. The doctor takes the loss, not the patient.

This is a PPO (same rules applied in the HMO I used to have). If you have one one the other types of plans where the doctor does not have a contract with the insurer, this may not apply.

The point is: Contact your insurer and see if they have this policy. Of course, also check to see of the claim was ever submitted.

I have had bills forgiven because of this, including one just recently.

 

Hi Jo,

Welcome to the board. You have a case here but you'll need to be a little patient. I know you just signed up but none of this stuff happens over night. And don't get angry. When EAGLES get mad they get smart.

Mitch very eloquently pointed out that implied consent is a behavioral thing. But implied consent works BOTH ways. They consented to allow you to assume that all was well with your bills and that they were being properly paid. For ALL of your previous visits to this Doc. everything ran smoothly. You paid your 25% and the Doc billed the ins co. ALL of a sudden this behavioral model failed to work. You had every right to assume that this bill was treated no differently than the others.

The real problem is that they did NOT notify you that there was a problem, which I'm sure you would have been delighted to help them straighten out had you known.

Also your Doc probably has an agreement with your ins. co. that they will bill "on your behalf". If they fail to bill the claim according to their provider agreement the responsibility is not yours. It's called a "Provider Liability".

Your next step is to follow the instruction IBrown pasted from my previous thread (scroll up). Call your ins. co. and explain the situation. Let them know that the Doc posted to your credit file. Ask if the claim was ever submitted and if so was it paid. Ask the CSR for a letter detailing the conversation to be sent to your home. We will use this to budge the Doc's office.

BTW it does not matter if you have the same insurance still. It's the insurance you HAD at the time of service that governs here. So don't be afraid to call them, they will help you.

We will await your post Monday to update us on the above.

In the meantime what kind of insurance did/do you have? HMO, PPO, or commercial insurance. Was it through yours or your husbands work? How big is this bill?



PS. Don't worry about validation right now. It's not an appropriate strategy just yet.

 

An absolutely BEAUTIFUL example of the application of Implied Consent. We can use their own language against them.