I'm a chiropractor in DE. I have a couple coming in for therapy for an accident which occurred 02/15/13 in which they went to the ER at a hospital. They started treatment in our office on 03/19/13. We sent out bills for a couple weeks of treatment the 1st wk of April. In DE, state law you must care $15K in PIP. Today I get an EOB stating the patient has a $2,000 deductible and the $1,050 we billed will have to be paid by the patient. Meaning we will have to wait until they settle to recover the money.
I called the claim adjuster and questioned if other bills were sent in from other providers before us. She said yes, but that the ER visit had not been billed yet. I find that nearly impossible since usually hospitals bill you in hours, not months.
Is there a way to investigate this?
I know this is probably a 1st for you guys, being that normally the chiropractors are on the other side of this. I just find it very difficult to believe the hospital hasn't billed or made their claim within at least the first 50 days (before we sent in our bills). That means that $2,000 deductible (which I've never even seen before in a MVA case) would have been eaten up. This is important to us as I'd rather not wait several months or possibly years to be paid. Thanks in advance for any information on what I can do to find out if the insurance company is playing fairly and paying bills in as they come (in order).
General Practice Lawyer
What a hassle.
Didn't you have the patient enter into a financial arrangement with you for payment of treatment bills regardless of the existence of insurance? That's your safety net. This indeed sounds fishy based on timing, but you have to ask yourself, what sort of resources do you want to expend to "investigate." Talk to your patient and ask them to figure this out for you. My guess is that your bills are fist in line and thus, you are facing the deductible argument.
In no way am I offering you legal advice, and in no way has my comment created an attorney-client relationship. You are not to rely upon my note above in any way, but insted need to sit down with counsel and share all relevant facts before receiving fully-informed legal advice. If you want to be completely sure of your rights, you must sit down with an experienced criminal defense attorney to be fully aware of your rights.
If you were injured, and it was not your fault, seek the representation of an experienced personal injury attorney to make sure that you receive maximum compensation. Good luck.
The above is general information only and is not legal advice. The information provided does not form an attorney-client relationship, and should not be relied upon to take or refrain from taking any action. I am not your attorney until we sign a retainer agreement.