I have great insurance, and after a recent accident I was treated by my physician. He treated me before after a previous accident and he submitted all my bills to my insurance. This time, he had me sign a lien against any potential judgment or settlement. I was under the impression that he was submitting all my bills to my insurance. He never discussed billing with me. I even paid the co-pays at his office. Now, my doctor refuses to send my bills to my insurance company, and wants me to pay the entire amount pursuant to the lien. Can he do this? Can I force him to submit the bills to my medical insurance? Will I have to pay him the full amount he claims I owe from my settlement?
Personal Injury Lawyer
That is an excellent question. It depends on the law of your state. You may be able to if your doctor is in network with the insurance company. You would be considered an intended third-party beneficiary of the contract between your doctor and insurance company. I have successfully argued that the doctor is entitled to no more than the amount he/she would have been entitled to if they had billed insurance. I suggest you speak about this with your lawyer.
This response is not intended to act as legal advice. I am not licensed to practice law in any state other than the State of Illinois. No attorney-client relationship is formed until you sign an attorney-client agreement with my office.
This is a question you should ask your attorney. I am not aware of any law which requires your physician to submit statements to your insurance company for payment unless he has a contractual relationship with the carrier. He may have had such a relationship in the past but does not now. There could be other reasons he does not want to be burdened with submitting the bills.
You, of course, are free to submit your statements to your carrier for payment according to your policy. They may issue a joint check, reimburse you, or pay your physician directly -- depending on your policy provisions. Your physician is entitled to full payment for his services unless he agrees to accept a lesser amount.
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Personal Injury Lawyer
In the typical personal injury case doctors sign liens because the client has no other means to pay for treatment. This gives the doctor a lien on your potential settlement or judgment.
It sounds as though your doctor is attempting to receive more by coming to you instead of your insurance. As you may know, insurance companies and doctors work together and doctors usually bill insurance companies less than someone paying out of pocket.
From a contract law standpoint, your doctor is allowed to recover from you via rendering services. Further, he can collect against your settlement or judgment via the lien.
The post of my colleague is very intriguing. A third party beneficiary argument may work and is definitely worth exploring. Contact your attorney to discuss.
One drastic option I am hesitant to state is to refuse to pay the bills and demand your doctor submit them to your insurance. If you do this, your doctor may sue to collect via services rendered and the lien. Yet, he may want to avoid litigation and go the insurance route.
One thing is for certain, contact your PI attorney now!
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Family Law Attorney
If you have not scheduled a consultation with a personal injury attorney, you should immediately do so. You did not post any facts about the accident. There may be issues of liability and potential monetary damages available. Attorney should assist their clients with medical bill issues. I do agree with my colleagues.
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You should contact a San Diego Personal lnjury Attorney immediately. You may have some significant leverage here but many more facts are needed.
If you do have an attorney, you may want to send him a written demand to not pay the lien until the matter is resolved. He will then hold the funds in his client trust account pending whatever settlement you reach with the Dr.
I am guessing that you may be at a point where settlement offers are either as good as they are going to get, or you have settled and the amount is not what you expected, so you want to negotiate the medical liens to allow more funds that you will actually receive.
Your attorney should have counseled you at the onset of your case, regarding when a lien is appropriate and when your insurance should be billed. If you have an attorney, and the amount of funds in dispute justify the expense, you may want to confer with another attorney to help you understand and wrap the matter up. The attorney will likely require a fee in advance, but depending on the money at stake, it may be worth it.
This answer is provided free of charge, for academic purposes only and is not intended to serve as legal advice for any specific circumstances. The question poster should confirm any opinions he or she forms as a result of this discussion with legal counsel as it relates specifically to their case, before taking any action on that opinion.
Personal Injury Lawyer
Do you have an attorney? If so, why are you not asking him/her? If you do not, then let me state that this is one reason that you should have an attorney to take care of this stuff for you. With that said, let me get off my soap box and try to answer your question. If you signed a lien, you might be responsible for honoring it. However, it strikes me that since you are not familiar with medical billing, and your doctor is, you were arguably mislead. I am sure you understand why the doctor is doing this. He/she will get more money from the lien than insurance. If you paid the co-pays, and the doctor accepted those, that can help your cause. Your remedy would be to hold the disputed amont of money when the case settles, and try to get the doctor to take a reduction later. If this is a small amount of money, you should just honor th elien. Good luck.
The above was not legal advice and cannot be relied on. For informational purposes only. Some of the time periods in which you are legal required to act can be incredibly short, some as short as 6 months. Time is of the essence, do not delay seeking legal advice and pursuing your legal rights. No attorney/client relationship formed.
Employment / Labor Attorney
This is very suspicious on the part of your Doctor especially since he took you co-payment. I would call the Doctor and ask for his lawyers address. Then send a letter to his lawyer and inform him that the Doctor took you co-pay thereby acknowledging the health insurance available for him to collect. This may be a part of a bigger scheme the Doctor is involved in related to billing practices. If he has done this with others there may be a potential mass joinder or class action against this Doctor for receiving the co-payments under false pretenses or some other claims. Investigate this as soon as possible.
Answering this question is not an agreement to represent the recipient or others. This answer is an opinion based upon the limited facts supplied and further research and analysis is required to render a full legal opinion. This opinion is that of the Law Offices of Dennis P. Wilson and is only premised upon California law and is not meant to be utilized in any other jurisdiction.