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    What is the legal precedence or law associated with this "responsibility". My doctor's office is claiming I owe for a visit (that I payed a deductible for) because, contrary to what their system told them, my insurance didn't pay them because they claim I wasn't covered at that time (which I was but that is a different matter). Now they're telling me I owe them $110 when had I known I would not have utilized their services, I would have waited a week and cleared things up with my insurance. It was just clarified to me by my doctor's office two days ago (the bill is from about 10 months ago but I received the first request for payment about 3 weeks ago and it didn't even say what the bill was for so i ignored it as it had to be a mistake). I don't see, in any way, how it is my responsibility. In fact, that day they sent me a letter which I received today...they are saying I must pay them in 10 days or they will report me to collections. I don't see how that's sufficient time to give anyone or how this is anything short of extortion. Where is my liability? It seems to me its a clerical error on the office's part which means its just a cost of doing business for them. How is it my problem that they think that they can force me to cover their losses due to their errors?

  • #2
    I have moved your post into its own thread. In future, please do not attach your question to someone else's thread no matter how closely the topics seem to match; it's too confusing for the responders otherwise.

    Have you cleared up the question of your coverage with the insurance carrier?

    Unless your insurance policy SPECIFICALLY says that it is the responsibility of your doctor to determine insurance benefits, it is YOUR responsibility to know what your insurance will cover, when you are covered, and to pay any balance not payable by insurance.

    Your ignoring the first letter because you "assumed" is was a mistake does not relieve you of responsibility. YOU incurred the service, YOU are responsible for seeing that the bill is paid. If your insurance doesn't cover it, again unless the policy SPECIFICALLY relieves you of responsibility for paying, it's up to you.
    The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.


    • #3
      Someone has to pay the doctor. The dr. deserves to be paid for services rendered. You utilized the services. It is your responsibility to see that the dr. gets paid.
      Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

      Live in peace with animals. Animals bring love to our hearts and warmth to our souls.


      • #4
        Have you talked to the person doing that billing at your doctor's office, or are you just reacting to the written threats?

        Most of the time if you discuss an issue like this with a doctor's office, they can straighten out the billing with the insurance company.

        Your post is difficult to follow. If you communicate in the same way with the doctor's office and the insurance company, it could be causing part of the problem.

        I think you are saying that your insurance was in effect at the time of the visit, and you now have that straightened out with the insurance company. If the insurance company has the bill on file, you should be able to request that they reprocess it. Also, call the doctor's office and ask them to re-submit the bill to the insurance company. Either one of these should work, but if you do both it is probably better in this case. Be courteous in dealing with them. They can fix your problem, but some are very difficult to talk to. Don't be rude no matter how idiotic or rude they seem to you.

        As far as legal liability is concerned, the doctor's office probably had you sign a form agreeing that you were responsible for payment of bills and they bill your insurance as a courtesy. So, you are probably legally liable. But, you should be able to work it out as I indicate above.
        Please post questions on the forum rather than sending me a private message or email. That way others who have similar issues have access to the discussion.


        • #5
          There were other issues with my insurance in the past. I was wrestling with different aspects of that and whether to properly bring them up in my post but it seems it just created more confusion.

          I did not sign anything saying I would agree to pay if my insurance did not do so. To say that my doctor deserves to be paid seems "loaded" to me. If you go to a car repair shop and you agree to have work done, then they do the work. If, however, when you return to pickup your car the bill is $300 more than you agreed to and they attempt to compel you to pay it, they can be shut down by the Bureau of Automotive Repair just for trying to get you to pay for something you didn't agree to. Though one could say that they deserve to be paid like my doctor, I did not agree to it; negating the relevance of whether they deserve to be paid or not. The same concept, as I understand it, applies to any financial transaction. Why would my doctor's office be immune?

          No, I have not been rude and I received one phone call two days before I received their demand letter saying I had 10 days to pay or be sent to collections and be charged an additional $20.

          I do not disagree that my doctor deserves to be paid but once someone begins threatening me (especially so soon in the discussion regarding the matter) it seems to me it just crossed the line from an attempt at resolving an issue to extortion. At my job I have and continue to risk losing my job by refusing to even attempt to charge customers for work I did not or could not give them an estimate for prior to the work. I prefer to have a zero tolerance for extortion. If they're doing it to me, they're doing it to someone else as well. I have not, yet, talked with my insurance company regarding this particular issue; I have not had the time to find their numbers etc and to call them during business hours since I have become aware of this matter.

          Everyone keeps saying its my responsibility, where is this written in the law? Are there any cases supporting this?


          • #6
            I have never heard of a doctor's office which does not require you to pay if your insurance company does not.

            At the time of the visit the doctor's office has no way of knowing details which would affect payment. For instance, if your insurance policy has a yearly deductible that has not been satisfied that will affect how much insurance pays the doctor's office.

            It is not exortion to try to get someone to pay for a service which was provided to them. I don't really think you need case law to show that you have to pay for something you received.

            You need to put on your big boy pants and deal with the issue. Perhaps a simple call to the insurance company will allow payment to be made.


            • #7
              Do YOU have any case law showing that it is NOT your responsibility?
              The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.


              • #8
                "big boy pants"? Wow, so much for avoiding personal attacks...

                No, I am not aware of case law either way, though I do understand, in general, one must agree to pay for services before one can be expected to pay for said services. I do know that for any sort of "repair" (such as a car or otherwise) one must receive an estimate and agree to the estimate before one is liable for the work.

                I was given the following story from someone who claimed to have experienced it first hand. There was some sort of water leak in the chassis or something of their car. Their car was under warranty. The repair location that would repair the car under the warranty said that if they took the car apart and weren't able to find the leak, then the warranty would not cover the work. The repair shop required that the customer, who owned the car, sign an estimate confirming they were willing to pay for that repair if, for any reason, the warranty company did not pay. The cost would have been several thousand to the customer but they would not proceed with the work until the customer agreed. There is a reason for that; if they had gone through it, been unable to find the leak or defect and had been unable to bill the warranty company, they would have been unable to bill the customer. If you go to the Bureau of Automotive Repair, for example, you will see that you must agree to the work otherwise they have no legal standing to expect you to pay.

                Pursuant to that story it is clear (and I would argue reasonable) that one must receive an estimate for a repair or service and one must agree to the terms before pay can be required. What if, in that story, they had forgotten to ask the customer to agree to the estimate? Of course those mechanics are entitled to be paid for their work but that does not mean that the poor customer, who didn't see it coming or agree to it, should be responsible for ensuring their payment. Who is to say the customer would have agreed to it had they been given an estimate? In that story the customer didn't agree to it so the repair never commenced so there was not confusion afterwords at all.

                HRinMA, you state that you have never heard of a doctor's office which does not "require" you to pay if the insurance company does not. Well, what does "require" mean? I know that sounds like a dumb question but to establish a "requirement" you don't just smack someone in the back of the head with it. You make it clear, concise and allow the person subject to the potential requirement to be fully aware of it so they can make proper decisions.

                To address the idea that the doctor's office doesn't know if I'm covered that is not accurate. That same doctor's office has done real-time checks on my coverage (and it would seem they failed for the visit which caused this whole issue) which caused me to not be seen on a subsequent visit due to a misunderstanding with my insurance. After that latter visit as well, then they, in real-time, confirmed my insurance again; so I know they can do it.

                I am not saying that I'm not going to call my insurance company and see what I can do, but part of me wants to understand this more in general. I find too frequently that companies compel people to make payments that, when you really break it down, are not truly liable to make and would not hold up in court. This conclusion is, of course, merely my understanding and may be contrary to whatever case law may arise which is why I'm asking to further reinforce my understanding or to crush it.


                • #9
                  dalydir, People here are trying to help you understand. But, I think it needs to be said a little more clearly for you.

                  1. You do not have a case. You are not being extorted.
                  2. You went to the doctor's office and received a service of some kind. You owe payment for that service. They accepted your co-pay pending your insurance company processing the claim and furnishing an EOB and payment of their share.
                  3. Something got messed up in the billing. We can't tell what, but part is that there was, at least for a time, a question as to whether your insurance was in effect that day. That is not the doctor's office problem - that is between you and your insurance company.
                  4. Your folksy car repair examples are irrelevant. But, if you do want to run a comparison, try showing up to pick up your car and tell them you won't pay the bill - in most places, you will not drive away in your car. They will not let you drive away, wait 10 months, and then say, "Pay or we'll turn this over to collections." They will say pay the bill or walk home. You can sue later or you can let your car sit there, accruing storage fees, awaiting legal action.
                  5. I have run into billing problems over the years with many different purchases of goods and services. The simple fact is, when someone else messes up your account, it takes your time contacting people often multiple times to get everything straightened out. -- eg it takes hours on the phone to straighten out a cell phone billing error.
                  6. Doctor's offices and insurance companies are just part of the mix. When there are problems, you need to take the time to talk to them and sometimes write to them to get things straightened out.
                  7. I suggested a method to deal with this problem in a previous post - a method which has worked many times, for me, for my family, and for others who have come to me for assistance -- and, I'm talking bills in the tens of thousands, not a mere hundred.
                  8. Talk to the insurance company and the doctor's office and get it resolved. You are really making a big deal out of nothing. And, I suspect your admitted ignoring of the bill has already made it worse.
                  9. I'm providing this post in response to your last statement "part of me wants to understand this more in general". I hope this helps. I understand you are confused and frustrated about this. Most people are confused as to why you think you wouldn't owe a bill for services you have received.
                  Please post questions on the forum rather than sending me a private message or email. That way others who have similar issues have access to the discussion.


                  • #10
                    What is comes right down to is that you owe for services rendered. You really do need to talk to the ins. co. & doctor's office to see if you can get this resolved.
                    Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

                    Live in peace with animals. Animals bring love to our hearts and warmth to our souls.


                    • #11
                      It would seem I may be speaking to the wrong crowd. It seems many people here have accepted, or would accept a requirement to pay for a service they didn't agree to pay for, which is unfortunate.

                      Scott67, I am sorry that you think that a car repair shop could do that to you without repercussions. I know that they could not do that because I have spoken with an attorney who was also a small claims judge for a short period of time. He had a repair done on a vehicle that was only several hundred dollars. When he returned the repair shop tried to charge him over $1000. His response was to demand that they remove everything from the vehicle that they did, immediately, or he would take it somewhere else, have them remove them, send the parts back to him and charge them for the removal. The repair shop owner, as this guy put it, probably realized the guy was wearing a several thousand dollar suit (meaning this attorney wasn't joking and was affluent with regards to his rights) and then just said "take it" and let the guy leave without paying anything but keeping all the parts etc. Now you ask why would a repair shop do that? Because they knew that they had absolutely no leg to stand on. Again, this was an attorney who I was speaking to regarding another matter and he brought this example up to me regarding trying to charge people for something that was not previously agreed to.

                      Some here may ask, if I am confident in these situations why would I ask about it in this forum? Because I am concerned that medical bills may have a different legal standing, however it would seem that no one here even agrees or understands the legal angle on the car repair shop perspective to begin with.

                      Scott67, if a mechanic ever tries to do that to you, then I would have sympathy for you because the mechanic would be taking advantage of you and you seem to be under the belief that the mechanic would somehow be in the right.

                      Barring any other responses that compel me to respond I think I'll stop perpetuating this thread at this point unless I discover some other outside information or experience something myself. At that point I will post on this thread to let people know what I found out.


                      • #12
                        Just found a page that I thought some people here might find interesting:


                        "By Law, the auto repair shop must provide a written estimate before doing any work."

                        "If the technician later determines that it will take additional work and will cost more to fix your car than the original estimate, someone from the shop must contact you, describe the additional work and cost, and get your permission to proceed."

                        I determined those were two key quotes that support what I've been saying.


                        • #13
                          When you fill out paperwork initially in a doctor's office, one form you sign takes responsibilty for payment if your insurance doesn't pay. If you were using the doctor's services for a long time you might not remember signing it. If you don't think you signed the form, ask the dr office to provide a copy of your signature.

                          You keep comparing it to unauthorized auto repairs. By allowing the doctor to treat you; you authorized the repair work to your person.

                          Insurance is how you paid a bill. So if you paid with a check that bounced or a credit card that was declined then you would still be responsible for the payment. Likewise if insurance is declined you still owe the bill.


                          The forum is intended for informational use only and should not be relied upon and is not a substitute for legal advice. The information contained on are opinions and suggestions of members and is not a representation of the opinions of does not warrant or vouch for the accuracy, completeness or usefulness of any postings or the qualifications of any person responding. Please consult a legal expert or seek the services of an attorney in your area for more accuracy on your specific situation.