Do I have to pay up?

[berryblend_]

If I go to a physical therapist and ask prior to the treatment how much it will cost and they say nothing, it is all covered by your insurance and I go to my appointments and I continually ask to make sure that this is all covered by my insurance and they continue to give me the same answer that it is all covered by insurance, there is no personal cost. But a couple months after completing all of my appointments they send a bill for the treatments and say that the insurance misinformed them of my deductible amount not having been met yet meaning that I should have been paying all along. Am I responsible for their mistakes?

 

[quincy]

If I go to a physical therapist and ask prior to the treatment how much it will cost and they say nothing, it is all covered by your insurance and I go to my appointments and I continually ask to make sure that this is all covered by my insurance and they continue to give me the same answer that it is all covered by insurance, there is no personal cost. But a couple months after completing all of my appointments they send a bill for the treatments and say that the insurance misinformed them of my deductible amount not having been met yet meaning that I should have been paying all along. Am I responsible for their mistakes?

What is the name of your state?

It appears that you are responsible for paying.

 

[zddoodah]

No, you're not "responsible for their mistakes."

However, you are responsible for paying for services received. I can't remember the last time I went to a doctor or other medical professional where I didn't have to sign something that clearly and unequivocally said that, while the staff will make every effort to confirm insurance coverage and bill the insurer, the patient has the ultimate responsibility for ensuring that the provider gets paid.

In your hypothetical, you might have a valid argument that doctor's staff negligently misled you about the insurance coverage and that, had you known the truth, you wouldn't have scheduled further visits.

So...is this something that has actually happened to you, or is this purely a hypothetical. If the former, what do the documents you signed say (assuming you kept copies)? Also, what is the relevant state?

 

[adjusterjack]

It's not a mistake. Yes, you are covered by insurance. But, yes, you do have a deductible and maybe co-insurance that has to be met before the insurance pays. If it's the deductible and/or co-insurance amount that you got billed for, yes, you do have to pay it.

It's entirely up to you to keep track of your medical bills and how much of the bills are your responsibility.

 

[cbg]

Unless your insurance policy expressly and in so many words says that it is the provider's responsibility to contact your insurance for you, then it's actually yours. They do it as a courtesy, but yours is the responsibility. The one who made the mistake was you, in not calling the insurance carrier yourself.

Yes, you are responsible for paying.

 

[quincy]

This thread is from November 2020. Reported for moderator review.