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small claims court appropriate?

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I live in NJ. In August 2000, my wife visited a doctor who we did not know was a "preferred provider" in our health plan. She paid the full charge for the visit, $385, on the day of the visit.

When I called our health plan to see if were entitled to any reimbursement, the plan informed me that the doctor is, in fact, a preferred provider, and we should not have been charged anything until the doctor submitted a claim and the claim was settled.

I called the doctor's office; they agreed to submit the claim, but not refund any of the $385 they had charged my wife. (?) When they filed the claim, they indicated that we had paid nothing.

When the health plan settled the claim, the benefits form indicated that we should only be responsible for $19.00 of the charge for the visit. I have called and written to the doctor requesting a refund of the excess charge ($366), but my requests have gone unanswered. So the doctor has now been paid by us AND the helath plan.

I have our original canceled check from the payment for the visit, the explanation of benefits form from my health plan, and a copy of a letter which my health plan sent to the doctor indicating that the contract they have with the doctor restricts the doctor from charging us any more than the $19.00 copayment. Is this sufficient material to present in a small claims court complaint, and is small claims court the appropriate way for us to handle this?

One possibly complicating factor: We live in Morris County, the doctor's office was in Warren County at the time of the visit, and the doctor has now relocated to Sussex County. Which county's small claims court would we file in?

Thank you very much for any suggestions.

Steve Langdo.


Senior Member
My response:

Small Claims court is the proper court. You file your case in the court that covers Warren County because that's where the doctor's medical service (i.e., that's where the contract) was executed and provided. Jurisdiction and Forum rules require the Complaint to be filed nearest to where the parties (your wife and the medical corporation) entered into the contract.

So, it would be your wife's name, versus doctor's corporation name, written in the complaint.

Good luck.



Thank you, IAAL. I think I'll send one more letter to the doctor letting her know that I plan to go to small claims court, to see if that shakes loose the refund.

I'm not sure that I know how to identify the doctor in the court filing. The check my wife wrote was made out to (doctor's name), M.D. The back of the paid check is stamped with "Deposit to the account of (doctor's name), M.D." And the benefits form from my health plan indicates that their payment was made to (doctor's name), M.D. I guess I'll do the same on the complaint & see what happens.

Thanks again,


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