Navigating the Legalities of Unbilled Medical Visits and Your Recourse

Introduction

Have you ever found yourself in a situation where a medical provider bills for numerous visits while neglecting to bill for others? This article explores the legality of such practices, the steps you can take to address the issue, and the potential recourse available to you if your insurance is not covering the unbilled costs.

What Happened to Me

A local medical provider recently faced scrutiny after failing to bill insurance for two visits, only sending the bill six months later, after the claim due date had passed. This incident raised several questions: Is it legal for a healthcare provider to bill for services and then not file an insurance claim? What are the steps you can take if this happens to you?

The Legal Implications

The provider's billing department agreed they should have filed the insurance claim and stated there was no way the patient could have been aware of the oversight. However, they argued that since the patient is liable for any claims their insurance does not cover, and the insurance company would not cover these bills, the patient was still responsible. They further claimed that the patient was liable for any harm caused by their negligence.

Strategy and Recourse

When faced with such an issue, it is essential to understand your rights and the steps to take.

Filing a Grievance with Your Insurance Company

First, you should file a grievance with your insurance company. If they refuse to take action, you can contact the relevant state authorities. This step is crucial as it helps establish that the issue is not just an isolated incident but part of a larger pattern. Additionally, filing a complaint can put pressure on the healthcare provider to rectify the situation and avoid future incidents.

Contesting the Bill in Small Claims Court

If the bill is less than the cost of hiring an attorney, you may choose to contest the bill in small claims court. This is a legal process that allows you to present your case and seek a judgment for the amount you believe is owed. Winning the case can result in the bill being dropped or the provider having to write it off.

Contacting the State Medical Board and Better Business Bureau

If the provider is a licensed medical professional, you can file a complaint with the state medical board. This action is especially effective if the provider has a history of similar incidents. Meanwhile, a complaint to the Better Business Bureau can influence consumer behavior and put pressure on the provider to address the issue.

Media and Public Scrutiny

In today's media landscape, negative publicity can significantly impact a healthcare provider's reputation. By bringing the matter to the attention of local news outlets or online forums, you can put increased pressure on the provider to resolve the issue. The provider may also be more willing to negotiate a resolution if they face potential negative media coverage.

Conclusion

Unbilled medical visits can pose significant challenges, both financially and legally. However, by understanding your rights and taking the appropriate steps, you can navigate these issues effectively. Always stand firm in your rights and do not hesitate to seek legal advice if necessary.