I found this and it seemed to really protect insured patients, but we sign our rights away on every doctor visit: (30.1) Failing to comply with the following provisions in connection with a contract for health care services between a physician and an insurer which offers a health benefit plan under which such physician provides health care services to enrollees: (A) As used in this paragraph, the term: (i) "Enrollee" means an individual who has elected to contract for or participate in a health benefit plan for that individual or for that individual and that individual's eligible dependents and includes that enrollee's eligible dependents. (ii) "Health benefit plan" means any hospital or medical insurance policy or certificate, health care plan contract or certificate, qualified higher deductible health plan, health maintenance organization subscriber contract, any health benefit plan established pursuant to Article 1 of Chapter 18 of Title 45, or any managed care plan. (iii) "Insurer" means a corporation or other entity which is licensed or otherwise authorized to offer a health benefit plan in this state. (iv) "Patient" means a person who seeks or receives health care services under a health benefit plan. (v) "Physician" means a person licensed to practice medicine under Article 2 of Chapter 34 of Title 43. (B) Every contract between a physician and an insurer which offers a health benefit plan under which that physician provides health care services shall be in writing and shall state the obligations of the parties with respect to charges and fees for services covered under that plan when provided by that physician to enrollees under that plan. Neither the insurer which provides that plan nor the enrollee under that plan shall be liable for any amount which exceeds the obligations so established for such covered services. (C) Neither the physician nor a representative thereof shall intentionally collect or attempt to collect from an enrollee any obligations with respect to charges and fees for which the enrollee is not liable and neither such physician nor a representative thereof may maintain any action at law against such enrollee to collect any such obligations. (D) The provisions of this paragraph shall not apply to the amount of any deductible or copayment which is not covered by the health benefit plan. (E) This paragraph shall apply to only such health benefit plan contracts issued, delivered, issued for delivery, or renewed in this state on or after July 2, 2001.
Kind of goes along with what we were discussing yesterday. Health care providers frequently add a disclaimor to the effect that patient becomes liable for paying the bill if claim for such services are not paid in a timely basis (usually 90-days). As I had mentioned before, in most states, the burden is on the healthcar provider to file timely claims with the insurance provider for all covered benefits. Failure to do so does not give the health care provider the right to refer the account to collections simply because they added a disclaimor on their website or bill! Nor does it give the health care provider the right to send an account to collections because they were not competent enough to submit an accurate claim for reimbursement! Short and sweet - in most states, stupidity or incompetence on the part of the health care provider or its assigns does not make the patient or their assigns liable for their lack of diligence/competence in handling medical insurance claims. Now you and I both know that it is not in the health care providers best financial interests to have to constantly write off accounts due to their inability to properly handle the claims paperwork. Obviously it is much easier to refer an account to a medical collection agency since the majority of consumers are not aware of their rights when it comes to health care providers and health insurance. Michael
Thanks for your reply, Michael. I have another question: What makes the dr's disclaimer override state law? Is it b/c what we sign is considered a waiver of our rights? I would think that if state law does not nullify federal law, then why would a dr's disclaimer/waiver override state law?
Could this be used to a consumer's advantage if the HCP has no proof that you agreed to their disclaimer?
Actually, that was kind of my point! Now it may require some research into each states case law to back this up, but typically the health care providers (doctors/hospitals) corporate disclaimor will not take precedence over applicable state/federal laws and as such in most states is not binding. But as I said before, most consumers do not know this and having read the disclaimor, assume it is gospel and are terrified when a medical collection agency calls trying to collect because someone in the food chain did not do his/her job. That is also why when challenged with facts - such as failure of the doctor (health care provider) to file a claim in a timely manner - the collection agency and the health care provider usually folds (in most states) because they know that for the most part they do not have a legal leg to stand on when it comes to the courts. I have a theory that this is why health care services are becomming more and more expensive. Although I have no hard data to back this up, I am willing to bet that 1 in 5 medical claims are either not filed in a timely manner or improperly filed and subsequently rejected. When the health care provider does not get paid they have a choice of either sending the account to collection where the informed consumer gets it sent right back or the doctor writes off the fee for service! Regadless of the outcome, either action obviously has the unfortunate side effect of driving up the costs of health care services! Michael
Hmmm... SENATE BILL 53 FAIR HEALTHCARE BILLING ACT OF 2001 HIGHLIGHTS: Every contract between a physician and an health insurer shall be in writing and shall state the obligations of the parties with respect to charges and fees for services covered under that plan when provided by that physician to enrollees under that plan. If the physician signs a contract in which he/she agrees not to balance bill the patient, the physician may not balance bill the patient. Violation of either of the above provisions constitutes a violation of the Fair Healthcare Billing Act. http://www.goma.org/legislation.htm It was effective as of July 1, 2001.
Hmmm... WTH???? HOUSE SUBSTITUTE TO SENATE BILL 53: "Georgia Fair Lending Act" Oh well.... Thought I was on to something...
Hmmm... My suggestion to anyone who gets a bill/statement for any medical services, call immediately !! I happen to do medical billing for a living and (thankully) I don't bill for internal errors. If we mess up( which again, thankfully) hardly ever happens according to our contracts you have to write it off. A insurance carrier can drop a physician for billing patients for services that would have been paid if billed on time or for balance billing. (If anyone has had that problem make a complaint with the insurance company, worked for them too) Also, the physycian as well as the individual doing the billing can be fined for fraud. Thanks, but no thanks, no job is worth that. But, again call ASAP, system errors happen and a patient bringing an error to someones attention IS appreciated. Also, sometimes a bill is sent correctly, deductibles, coinsurance, etc. don't ignore a statement just because "you have insurance and they should have paid everything" I can't tell you how many times I have heard that, after I sent statements for 4 months and indicated collections are next. Quick note, I try to avoid that last step at all costs, since I am one who is trying to straighten out my own credit problems. Take that minute to call and find out, don't ignore it, not all of us in that field are bad people and it's the same in this industry. I rather work out something than write it off and get nothing. Learning a lot on this site, which is helping me.
Re: Hmmm... Could this be used to a consumer's advantage if the HCP has no proof that you agreed to their disclaimer? QUEEN_BEE =================== Two parties cannot write an agreement between themselves that is contrary to law. Such an agreement would not be legally enforceable. The END ************************* LB 59
Re: Re: OCGA re: medical bills What makes the DR's disclaimer override state law? Is it b/c what we sign is considered a waiver of our rights? QUEEN_BEE ======================== It really doesn't: Here is why and it comes under contract law: Any contract has to be written within the scope of applicable law. What this means is that any clause in a contract that is in violation of law is null and void and is not legally enforceable. The END ************************* LB 59
Re: Re: OCGA re: medical bills Just because it's on the HCP new patient/insurance forms doesn't allows make it accurate. Any document can have certain items listed that legally you can't be held liable for. HCP forms , leases, just defer, make a notation that you do not agree , and don't sign. I've had plenty of people who actually read those forms do that and there's nothing that can be done. You can't be refused treatment just because you don't agree with the way an office/facility words their paperwork. Unortunately most people just sign those forms without reading them and that's what their counting on.
Re: Re: Re: OCGA re: medical bills Found that in writing: OCGA 1-3-10. Except for wills of personalty of persons domiciled in another state or country, when writings or contracts are intended to have effect in this state they must be executed in conformity to the laws of this state.
