Doctor billed insurance 6 months later, am I still liable?

[darkrib400]

Hi, I'm from PA and searching for an answer to my question.

In March I was 21 having back problems. I was still under my parents insurance through their work and told them that I wanted to go to a Chiropractor. They picked out out that was a preferred provider and made an appointment. I went to him three times in March and paid the $15 co-pay each time. In between those three appointments and after the last one I got called several times by the secretary telling me that my appointment had been canceled. The Doctor's father was dying so it was understandable. About five appointments got canceled and my back was starting to hurt more and more so I told my dad that I wanted to go to another Chiropractor. Another reason for this urgency was that my insurance would expire at the end of April (due to me turning 22 at the end of March and the insurance covering me for an extra 30 days) so we wanted to get me treated while I was still covered and the co-pays were still cheap. The doctor and at least one of his secretaries was aware of this fact.

Afterward, my dad called the first Doctor up, left a message, and canceled my appointment and stating that all further appointments would be canceled. I got an appointment with another Chiropractor the next day. We informed him that our health plan only allowed 12 visits and we already used three, but he said that we could just pay the $15 co-pay after our insurance wouldn't pay anymore and it wouldn't be a problem. He did hold true to his word, only charging me $15 for the visits until I got different health insurance.

In late August, we started getting statements from the insurance from the first Chiropractor, then we got a few more in September. A few weeks ago I got a letter saying that my insurance visits for spinal manipulation have been exhausted and that I owed them $240, but as a courtesy the doctor agreed to only charge me $156.

Basically what happened was, they submitted the bills to the insurance way late and the second Chiropractor that I visited used up all 12 visits on the plan, when I thought that he would have only used up the nine that I thought were remaining. My dad went into their office the other day to try to resolve this but he said that the secretaries weren't being helpful and claimed that they had one year to submit the bills to the insurance. That may be true; however, the only reason that I went to this Doctor is because he is a preferred provider and I would only have to pay the co-pay. I would have never went to him otherwise. Considering that had his secretaries submitted the bills when I had my treatment (or even when I canceled all future visits), and I only went there because I only expected a co-pay, am I still liable for this bill? Would I have a shot in small claims court?

I know you could argue that I would have had to pay the other doctor anyway, but he only charged me the $15 co-pay after my visits expired so that argument doesn't work. Thanks for any help in advance.

[Zigner]

so, to sum it up...
You had x number of visits allowed per year by insurance.
You went x+y number of times.
Now, you want to know if you are responsible for the y number of visits.

The answer is YES

[ecmst12]

You owe whatever the contracted rate for the visits were. You used more then the allowed number of visits and the first doctor never agreed to charge you less then the insurance rate for the visits. They weren't denied for late filing, they were denied because the benefit was exhausted.

[darkrib400]

12 Visits on health plan
Went to doctor #1 three times in March
Switched doctors due to dr. #1 canceling too many appointments
9 visits left on health plan
Went to doctor #2 at the end of March, told him that I had nine visits to use. He said that after that he would only charge me the co-pay, and he did.
August/September, doctor #1 submits insurance bills, long after the second doctor did.
Second doctor got paid for 12 visits instead of 9 due to first doctor submitting bills way late.
Second doctor now charging me because he decides to bill the insurance 5-6 months later.

I don't see how I'm liable for this. I ONLY went there because it was a preferred provider and I knew that it would be covered by my health insurance. Had doctor #1 submitted the bills in a timely manner then the insurance would have covered this.

[justalayman]

they did file them in a timely manner.

A timely manner is 1 year in this situation.

[ecmst12]

You're liable because you used more then the 12 visits allowed. Repeating your question is not going to change the answer.

[darkrib400]

I repeated my situation because I'm not sure anyone here understands the situation. When I went to the first doctor I had 12 visits to use. Had they submitted the bills in a timely manner then the insurance would have covered me. I do not feel like I owe them any money because the only reason that I went there was because I knew that I would only have to pay a co-pay, which did not turn out to be the case BECAUSE they chose not to submit the bills when I canceled all future appointments. This is really poor business on their part.

[justalayman]

and like I said, they did bill it in a timely manner. The insurance company is who determines what a "timely manner" is defined as and they apparently allow up to a year in your situation.

Additionally, you most likely would have revieved EOB's explaining what the insurance paid and what it didn't. You apparently ddid not get any EOB's because it wasn't billed yet. You should have noticed that problem.

and the third thing; you have a phone, right? You could have called the insurance company and verified your situation. That would have resolved all your questions yet you didn't.

So, as ecmst12 stated, repeating things does not change them. We DO understand the situation and regardless if you want to accept it or not, the only fault in all of this is yours.

If anything, you should be upset at the 2nd doctor. If he agreed to only charge you the co-pay after the 9 visits you siad you had available, he had no reason to bill the insurance company. It was his additional billing that caused the 1st doctor to not get paid by the insurance company.

So, pay the first doctor. You owe him.

[momm2500]

according to you your insurance will cover 12 chiro visits. with that being said 12 visits is 12 visits no matter who bills for them. anything over and above the 12 visits is your responsibility. what probably happened is the 2nd chiropracter called the insurance company and they said you had 12 visits cause they did not receive the 3 visits from the first doctor you went to**************so you owe the bill.

[cbg]

I've got news for you. You have to pay for the visits no matter what.

Where did you get the idea that it was anyone's responsibility but yours to pay for a service that YOU incurred? When you go to a doctor, it is your responsibility to pay or see that he is paid. If the insurance doesn't pay for whatever reason, what makes you think that you are entitled to have that service for free?

You are entitled to 12 visits. You had more 12 visits. What might have happened had someone else done something different is irrelevant. YOU incurred the bills; if they are not covered by insurance YOU get to pay for them.

[ecmst12]

Not to mention that the 2nd doctor agreeing not to charge you once your insurance visits were used up is a fairly shady practice...