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If I was in a not at fault car accident and I have an hmo health insurance,why is my Dr. demanding I do a L.O.P.?

Tampa, FL |

If I was in a not at fault car accident and I have an health insurance,why is my Dr. demanding I do a Letter of protection?The Dr. is actually listed in my health insurance provider book but once they heard I have an attorney they switched from taking my health insurance to L.o.p.I heard its because they will charge like $80,000 for my surgery instead of getting paid by the contract rate by the health insurance company of $2200.Isnt there some sort of ethics that they cant rip off people.Is this fraud?My health insurance company said even if its a auto accident,all insurances will pay and that you have to pay them back at their rate when doing subrogation.ALso what if an attorney is allowing this too happen to clients?Is it malpractice on there part?

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Attorney answers 9

Posted

You control who you see, not your lawyer. You should make decisions with informed consent from your lawyer and doctors. That said, this is an answer that requires us to know more about the individual situation and since you are represented, you should have that conversation with the lawyer you are paying.

Our office accepts clients off of Avvo, but this initial impression is not protected by any privilege, is not attorney-client communication and you should consult a lawyer promptly about any legal matter.

Asker

Posted

Im sure theres some sort of ethics involved in this and its fraud

Posted

You can choose a different doctor. If they are in network, they should bill health insurance. Many providers require an LOP for the co-pay, deductible, or co insurance. You need to clarify with the doctors office that they will bill your insurance and that the LOP is for your out of pocket portion only. The LOP itself should specify. You can also clarify this with your attorney. That is what they are there for. Best of luck to you.

Although I am happy to give my opinion freely based on my knowledge, experience, and training as a personal injury attorney, the opinions I give in response to questions posed on AVVO should not be construed as legal advice and should not be relied on to make legal decisions.

Asker

Posted

this certain practice demands lop for the entire amount not just the deductible or copay..been going on for years,leaving the poor injured people who had surgeries or services with peanuts when it comes to settlements because they absorb most of it,

Alyson Marie George

Alyson Marie George

Posted

They may be an "out of network" provider. In any case, you always have a choice. You don't have to treat with that doctor. You do need to speak with your attorney about it and if you feel pressured to stay with a doctor you think is doing something you don't like as far as billing goes, then you have a choice about lawyers too.

Asker

Posted

they are in network.If someone writes on the lop"must bill health insurance first and this is for a back up"will this protect a client if when the case is resolved that they were told to bill health insurance first?

Asker

Posted

Theres a big practice in florida called "winters and yonker"that got nailed for this by having there clients do letter of protections with a certain surgeon and the clients hired a malpractice attorney and winters and yonker had to reimburse the clients money that they spent on an lop as the dr. was in contract with insurance company.I think its unfair the attorney got blamed as the dr. was the unethical one.

Alyson Marie George

Alyson Marie George

Posted

It's hard to say without reading the entire LOP, but language like that is often use in LOPs to protect you and to require the doctor to bill insurance. If I were you, I would ask for an office conference with your lawyer to review the LOP and talk about how important it is to you that the doctor bill health insurance (and that the LOP reflect your wishes in that regard) - ESPECIALLY before you have any major procedures.

Posted

This is all your decision. You can choose to have whatever treatment options are available. Make the best choice you can. An experienced accident attorney should be able to give you choices and options that hopefully will work with what you are trying to accomplish. Whatever you decide, I hope you get the medical treatment that you need and I hope this was helpful. It is important to use an experienced accident attorney in the Central Florida area to help you.

Posted

As indicated by others, you have total control over your case. Your attorney is there to advise and counsel you. LOP's are pretty standard, and yes, most of the time they go towards deductibles/co-pays, etc. You probably should clarify things with the doctors and your attorney and get the medical attention it sounds like you need.

Posted

Unfortunately, this issue is arising more and more in car accident cases, and there is no easy solution. Whether your doctor's office can refuse to accept your insurance, and charge you "retail" probably depends upon what his managed care contract with your group health carrier says. Even if the contract allows the doctor to reject your insurance, I would think that your group health carrier would want to know this, and it may cause them to end their relationship with this doctor.

If you don't like the way you are being treated by this doctor's office, perhaps seeking a second opinion from a more cooperative doctor's office is in order? Is there any permanently tying you to this doctor's office.

Your health insurance people are correct - you do have to reimburse them for any accident-related expenses they pay. However, it is obviously a better deal for you to pay back your group health carrier for what they've paid under a managed care contract, versus paying back the doctor's office for the "retail" price of the procedure. Even though the "retail" price is very negotiable, the doctor's office must feel like they have a better chance of netting more by dealing with you, rather than accepting the rate under their managed care contract. (Maybe they should have negotiated a better deal with the insurance company up front?)

Other than changing doctors, there isn't going to be much your attorney is going to be able to do other than attempt to negotiate your bill in advance of the procedure, or negotiate the bill after you receive a settlement offer or jury verdict.

It probably doesn't make you feel any better, but you are not alone on this. This is an increasing problem for accident victims across Florida.

I am licensed to practice in law in Florida, only. Any information or insight that I provide for scenarios outside of Florida, is provided for general information purposes, only. Nothing that I post on this forum should in any way be construed as legal advice.

Asker

Posted

Theres a big practice in florida called "winters and yonker"that got nailed for this by having there clients do letter of protections with a certain surgeon and the clients hired a malpractice attorney and winters and yonker had to reimburse the clients money that they spent on an lop as the dr. was in contract with insurance company.I think its unfair the attorney got blamed as the dr. was the unethical one.

Posted

You need to address this with the attorney that you have handling the case. As to the medical care/surgery issue, if you don't want to provide LOP and insist on submission to health insurance, simply find a doctor on your plan that will do the surgery and tell lawyer you want to go there. In either event you should discuss with your lawyer as the testimony of the doctor and his willingness cooperate may have a drastic impact on your legal case. As to the not billing insurance, IF YOUDONT TREAT WITH THAT DOCTOR, talk to your lawyer about filing complaint with insurance company and the board of medicine as there are contracts for health insurance that require doctors to accept health insurance payments.

Posted

Whether your doctor is bound to accept you as an HMO patient is governed first by his contract with your insurance company. Some doctors also reject Medicare in this situation and try to collect on larger bills through the tort settlement. Practically, I suggest you do not worry about that, and just switch doctors.

If you think your lawyers are involved in some overbilling scheme, first talk to them, and if you are still convinced, just get a new lawyer.

This is a summary based on incomplete facts. You should not rely on it as legal advise. No attorney-client relationship is intended to be formed.

Posted

You are the master of your own destiny.......

L. Vincent Ramunno

L. Vincent Ramunno

Posted

so true

Posted

Letters of protection (LOP's) are common with some doctors and in some states, talk to your attorney or his/her staff about the dr's demands

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