Should i pay a provider that lied about being in network and billed me almost two years later?

Asked almost 2 years ago - Newark, NJ

I was informed by his staff that the provider was in network with my insurance company. I paid my co-pays for the times i was seen at his office, but now almost two years later I've received a "final notice" to pay a balance of $230 because the office was out of network with my insurance. I had never been contacted about this before and services were done in November 2011. Do i have the right to request a write off being that i was told they participated with my policy and amount of time from date of service and billing date?

Attorney answers (4)

  1. Christopher Edward Ezold


    Contributor Level 17

    Answered . I am an attorney licensed in the Commonwealth of Pennsylvania, and the States of Delaware and New Jersey. My practice includes employment, business and health care law. Before I respond to your inquiry, I must state that we have not spoken, I have not reviewed the relevant documents and facts, and I do not represent you. Therefore, my discussion below is not a legal opinion, but is informational only. Finally, my discussion applies only to issues to which Pennsylvania, Delaware, New Jersey or Federal law applies.

    That being said, it does not appear that you owe the monies. You should complain to your insurance company, as they may have had a contract at one time with the provider which would have prevented this issue.

    /Christopher E. Ezold/

    The Ezold Law Firm, P.C.
    Employment, Business and Health Law
    One Belmont Avenue, Suite 501
    Bala Cynwyd, PA 19004
    (610) 660-5585

    I am an attorney licensed in the Commonwealth of Pennsylvania, and the States of Delaware and New Jersey. My... more
  2. Alan Jay Dion

    Contributor Level 14


    Lawyer agrees

    Answered . I would say, no. Don't pay. Tell them you retained the doctor because you we're told that the doc was in network and if it was a mistake you should have been informed much earlier when you could have done something about it. wait to see if they do anything"

    This answer is not intended to be legal advice in a lawyer/client relationship. Misunderstanding of the answer or... more
  3. Norman Antonio Stiteler

    Contributor Level 15

    Answered . While I generally agree that you shouldn't have to pay, it is a debt that could come back to haunt you.

    I am licensed in New Mexico and Pennsylvania, and therefore any discussion of issues related to other states must... more
  4. Carolyn Barnes

    Contributor Level 5

    Answered . Send a letter disputing the debt certified mail return receipt requested. Then, notify all three credit bureas of the dispute and send them a copy of the letter disputing the debt and copy of the green card showing where the doctor received it. You have a right to dispute the reporting of this debt on your credit. Often if the doctor does not timely respond to the dispute, it will be removed from your credit and go away.

    Every case is different and it is difficult to get a true feel for the case from these limited postings, so please... more

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