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I Owe CoPay on Trumped Medical Billing? - Fox Guarding Hen House / Small Claims Court

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shibumi

Junior Member
California. Podiatrist screwed up my foot surgery. I also paid $700 for orthotics. After 3 tries in not providing orthotics made correct as verbally promised, I quit and insisted they refund me the $700. Then they "audited" their medical billing and found errors and rebilled my insurance for them and said I owed copays on those billings they had missed. This has been over the course of several years and my having to have a second surgeon do a salvage operation on that same foot, costing me a lot of money. I cannot remember all the details. The problem is they insist on taking me to small claims court over $277. I think they are angry because I did file a factual and negative report on them with the Better Business Bureau. HOW CAN I WIN a case in small claims court where they handle billing and understand all the ins and outs of it and I cannot remember all the details? Is this not the fox guarding the hen house? :mad:
 


justalayman

Senior Member
don't know. Not enough information to give you anything specific.

The first thing; are the co-pays actually valid charges. If not, you fight them on that.

then, depending on how long ago any of the charges are from, there might be a valid argument under the theory estoppel. Hang on for Tranquility. I know he will have the the specific type of estoppel that may be applicable. He usually corrects me when I use the wrong one so I figure I'll save him the trouble of correcting me and just tossing out the right one to start.

other than that; who knows?
 

justalayman

Senior Member
well, you know what a co-pay is, right? It is a portion of the bill you are required to pay, regardless of how much the insurance picks up otherwise.

if you were not required to pay a co-pay, it would be an invalid co-pay.
 

commentator

Senior Member
Do you not have all the billing information that was sent to you, such as Explanations Of Benefits from your insurance company? If you didn't keep up with your own billing and insurance matters, blindly trusted the physician to bill you correctly and your insurance to handle it, especially since you have been having on going problems with this provider for several years, they weren't the ones who let the fox in the henhouse, you were. But I would suspect you could obtain copies of all the billings that have been submitted to your insurance by this particular health care provider, wouldn't be a bad idea to go through these thoroughly before you try to represent yourself in small claims court.

If you really saw this doctor say, six or seven times over the last couple of years, with a $40 co-pay for each visit, it sounds to me like these might be very legitimate co-pays, whether or not the services during these visits they provided satisfied you or had to be redone or whatever.
 
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cbg

I'm a Northern Girl
Read your insurance policy.

If it says expressly and in so many words that you do not owe co-pays on missed billings, then you don't. If it doesn't expressly and explicitly say that you don't, then you do.

I know without looking that your insurance policy does not void co-pays if you are dissatisfied with the work done, so you're out of luck on that score. Your only hope is if the policy excuses you from co-pays for missed billings (unlikely but just barely possible).

Please note; it's not enough if the policy fails to say that you DO owe them; as long as it doesn't say that you DON'T, then the doctor's office is on firm legal ground.
 

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