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What are patients billing rights and how do I proceed? PT demands payment from me when we agreed they'd use my health insurance.

San Diego, CA |

Accident 2 years ago. I was paying Cobra for health insurance. I used a certain Physical Therapy co. b/c my health insurance approved them. They billed my Health Insurance who paid. Then after those sessions were exhaused the PT co. called me and said we heard you got a settlement, so pay us. They said they didn't get much from my health insurance so they wanted me to pay them instead. I explained that's not what we agreed to considering I paid co-pays and significant amount to cobra health insurance. They keep coming back to me, they reimbursed my past health insurance company. Isn't this illegal? Don't I have the right to use my health insurance? How do I properly tell them to leave me alone? I don't have extra money. Please help asap. thanks!

Attorney Answers 2

  1. I seriously doubt any medical provider agreed to take less than full pay on such an injury course of treatment. A PT provider has a lien on settlement proceeds if you sue and recoup. That there is an offset from your insurance and copay does not absolve you from having to pay for the full cost of PT, in all instances I have ever seen.

    If, on the other hand, you have it in writing signed by them and dated that the PT provider will take only what is collectible by them from insurance proceeds and your copay then you have a contract to enforce and defend against their current collection efforts.

    Yet, I cannot imagine a PT provider would ever in a million years agree to take less than full payment. I have never seen that, ever and I have been doing this practice of law for over 25 years.

    Good luck and I hope this helps you understand.

  2. In order to participate in a particular insurance plan, medical providers will negotiate with health insurers and agree to take less than full payment for the privilege of being included in the health insurer's plan. Pursuant to the contract, the provided is usually precluded from seeking any excess payment from the patieint. You should first determine if the physical therapist was a participating provider. If so, you may be able to get your health insurer to remind the therapist about thier contractual obligations to the health insurer's members

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