Asked over 1 year ago - Chicago, ILFlag
Physical therapy company put a lien for fees and cost against my settlement with the insurance company. My insurance company claims that: "No documentation has been submitted to substantiate type of service. Therefore, type of service has been denied."
Do I have any right against physical therapy provider since they have not billed properly?
Am I personally responsible if the settlement doesn't go through?
Additional info: car accident related injury (not my fault)
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Not sure I fully understand your question. The general rule is that when you go for medical treatment, you are responsible for the bill. In order to protect their bill for services, they may submit a lien against any personal injury settlement you receive. If the insurance company receives that lien, they will include the medical provider's name on the check. If they don't they generally do not put them on the check. In your question it is unclear which insurance company is paying you. If it is a settlement from the adverse driver, they may not include the amount of the bills in your settlement if they don't know what treatment was provided. If it is your insurance company, and they are paying under your medical payments coverage, they may make similar requests. If you have a lawyer, you definitely need to discuss this with them. If you don't, proceed with caution. Insurance companies often make you a lowball offer and don't tell you that you still have to pay back the medical bills. For example, if your insurance medical payments coverage made payments, they may have a right to get repaid from your settlement. It's a tricky area of law. If you are unsure, you should consult a lawyer for some advice. Best of luck.
You question is vague and confusing. Medical providers are permitted to lien your recovery, provided they have properly perfected the lien. These are questions you need to discuss with your attorney. You should not be attempting to settle an injury claim without one. You are responsible for paying (or ensuring payment from your recovery) for medical services received, even if there is some billing issue. Again, talk to your lawyer.
Not sure I fully get your question either but I suspect you are saying the health insurer won't pay the PT bill. My guess is the PT facility coded it incorrectly.
Keep in mind that YOU are responsible for all bills you incur regardless of whether you have an injury suit, so they are within their rights to place a lien upon your case.
You probably can appeal such a decision and resubmit your bills, once properly coded, pursuant to your policy.
If you have a lawyer handling this, I suggest you consult on this question with him or her. If not, a good personal injury attorney might be able to assist you.
Stephen L. Hoffman
Law Office of Stephen L. Hoffman LLC
It sounds like physical therapy bills were submitted to either your health insurance or your medical payments coverage on your auto (which seems more likely).I would suggest you submit the bills and records to that insurer and see that the pay this bill. it.It is likely that you could net more money if you follow this procedure but your inquiry doesn't provide enough information.The sticky issue is whether your health or auto insurance have rights to reimbursement for any related medical payments made on your behalf.Most policies include that provision which in Illinois can usually be negotiated.I don't believe you have any lawful dispute with the therapists or their billing practice.
Without question you need an experienced attorney to review this if you do not have one already.
That attorney will first determine if the medical provider lient was properly put into place. If not, then that attorney could, in fact, challenge the lien by requiring the provider to demonstrate how and why they claim they are owed payment for services. This in turn will require them to submit their billing for services which should satisfy the requirements for payment by the insurance company.
If the physical therapist fail to provide documentation substantiating their bill, then while you may have received services you can not be expected to pay if the provider wont demonstrate what you are actually being billed for. Courts will often adjudicate, void and or bar any liens that fail to inform the patient or insurance what the services provided were and how much those services cost.
Additionally, those costs for services can be reduced as well and likely would be reduced when your attorney contacts the provider. In the event you do nothing you will indeed be held responsible for that debt.
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