Alpona

Hi,
Before I get flamed...I am a K1-er !!
Am facing a funny situation and since there are so many knowledgable
people on this forum, I thought I could maybe get some advice on this
strange predicament.
Last March we got rear-ended.Filed a case for compensation.
I saw a chiropractor for about 4 months on a pretty regular basis.
Now my husband's insurance has paid the chiropractor.
The chiropractor is a provider(is that the correct term?) for that
kind of insurance(its a PPO plan).He is supposed to waive 50% of the
bill as the discount.
Unfortunately yesterday i got a call from his office.They said the
discount is not valid since we have litigation on for damages and they
expect the full amount.If I had not filed for damages....the bill was
paid for and the matter closed.
Has anyone else faced this problem before?Is the doctor just being
greedy and taking us for a ride or does he have a leg to stand on?
The Insurance company didn't think he could do that.
Any input is valuable....the amount involved is about $2,500 so it
means a lot to us.
Regards,
alpona

Alf

"alpona" wrote in message
news:[email protected]...
    > Hi,
    > Before I get flamed...I am a K1-er !!

Right newsgroup.

    > Am facing a funny situation and since there are so many knowledgable
    > people on this forum, I thought I could maybe get some advice on this
    > strange predicament.

Wrong newsgroup. See: misc.legal.moderated

Alpona

Hi,
Why I posted this on this newsgroup is that I feel bound emotionally
to this group somehow.Been here since the last two years now!
We do discuss OT topics too....
I just thought with so meany people here with so many diverse
experiences....someone may have something to offer.
I know very little about doctors and medical insurance and the rest in
the US. Its somehow comforting to think there is a forum where we can
just talk......as spouses and fiances of US citizens.Sometimes there
are issues we face apart from visa procurement which do impact our
lives and the people on this group are the largest bank of experience
and advice we have to fall back on.
If this irritates anyone...sorry....didn't intend to waste your time!
regards,
alpona

Rete

I'm not irritated by your quesiton. However, I live in a no-fault state and here in New York any medical bills incurred due to a car accident is made by the auto insurance and not your medical insurance. Thus, I am not sure if what the doctor's accountants are doing is legal or not.

I know that when you complete a medical questionnaire at the start of your relationship with a physician you are asked if this visit is due to an accident. Did you have to answer a question such as this? Were they and your insurance company aware that your visits were due to an auto accident?

The best advice I can come up with is that you contact your PPO and ask their advice on this situation. They, afterall, at the ones that are part of this contract for payment with the doctors.

Rete

Mrtravel

alpona wrote:
    >
    > Hi,
    > Before I get flamed...I am a K1-er !!
    > Am facing a funny situation and since there are so many knowledgable
    > people on this forum, I thought I could maybe get some advice on this
    > strange predicament.
    > Last March we got rear-ended.Filed a case for compensation.
    > I saw a chiropractor for about 4 months on a pretty regular basis.
    > Now my husband's insurance has paid the chiropractor.

Was this his car insurance or your standard medical insurance plan?

    > The chiropractor is a provider(is that the correct term?) for that
    > kind of insurance(its a PPO plan).He is supposed to waive 50% of the
    > bill as the discount.
    > Unfortunately yesterday i got a call from his office.They said the
    > discount is not valid since we have litigation on for damages and they
    > expect the full amount.If I had not filed for damages....the bill was
    > paid for and the matter closed.
    > Has anyone else faced this problem before?Is the doctor just being
    > greedy and taking us for a ride or does he have a leg to stand on?
    > The Insurance company didn't think he could do that.
    > Any input is valuable....the amount involved is about $2,500 so it

If you were involved in a car accident, then the auto insurance should
cover it, at least partially.
If you were rear ended, generally the other person was at fault and
their auto insurance should be billed. Why should you (and others) pay
(through PPO) premiums for expenses caused by someone who rear ended
you?

Mrtravel

Rete wrote:
    >
    > I'm not irritated by your quesiton. However, I live in a no-fault state
    > and here in New York any medical bills incurred due to a car accident is
    > made by the auto insurance and not your medical insurance. Thus, I am
    > not sure if what the doctor's accountants are doing is legal or not

In my experience, there would be no deductible for the medical part of
the auto insurance, either your own or against uninsured drivers. If
they were rear ended, the other person's auto insurance should pay the
bill, not the injured person's PPO plan. I believe the Chirpracter
should get the full payment, because this is something that should not
be paid by the PPO plan and not subject to the discount offered to the
PPO plan. The injured person should file a claim with the other person's
auto insurance carrier, or with there own auto insurance carrier.

Rete

In a no-fault state, your insurance company pays the medical bills regardless of who is at fault for the accident. It is the cost of auto repair that the issue of who reimburses your insurance company after the auto's repair. For example your car is insured by you for collison. Your insurance co. pays for its repair minus your deductible. They in turn will go after the other insurance co. if the other driver is at fault for reimbursement of the monies paid you plus the deductible which you will then be given when received by them.

Dekka's Angel

This situation appears to be your chiropractor trying (badly) to assert what is known as a medical lien against any recovery you ultimately get from the third party who rear ended you. The validity of medical liens (despite the agreement with your insurance company as a PPO provider to accept a partial payment as payment in full for being listed as a provider) and the chiropractor's ability to collect the differential from you after-the-fact will turn primarily on your state's law about the litigation you have pending. It All Depends on a lot more facts than you can reasonably discuss in a newsgroup. So you might want to invest in 1/2 hour consultation with an attorney to get the answer to your question.

Alf

"alpona" wrote in message
news:[email protected]...
    > Hi,
    > Why I posted this on this newsgroup is that I feel bound emotionally
    > to this group somehow.Been here since the last two years now!
    > We do discuss OT topics too....

Sorrry for being straight forward. I just believe you will
get a much better and accurate information in the right
newsgroup because people there are more informed
about specific legal issues.

David Brown

Yes, chiropractors are greedy. He agreed already to accept what the "auto"
insurance would pay. He cannot bill twice for the same services for example
now bill your medical insurance.

Remind him of this and the problem will disappear. You do not owe the
money.

Chiropractors do not fear their own weak kneed wishy washy regulatory
boards.

They fear the Insurance Commissioner.

Alpona

Thanks Rete and Mr Travel for the input.
My lawyer had suggested I try and get the payment made by the health
insurance.
They said when we settled with the other party , it would leave us
with some money as compensation for the trauma etc.
Lets see how it goes!
Regards,
alpona

Mrtravel

alpona wrote:
    >
    > Thanks Rete and Mr Travel for the input.
    > My lawyer had suggested I try and get the payment made by the health
    > insurance.
    > They said when we settled with the other party , it would leave us
    > with some money as compensation for the trauma etc.
    > Lets see how it goes!
    > Regards,
    > alpona

Did the other party have auto liability insurance?
Their auto insurance should have paid your medical bills.
Or you auto insurance should have.

Alpona

Dekka's Angel wrote in message
you might want to
    > invest in 1/2 hour consultation with an attorney to get the answer to
    > your question.

Hi,
What kind of Attorney would that be?I mean who do I look for in the
yellow pages...someone specialising in what law...?
Sorry if this sounds dumb..!
regards,
alpona

David Brown

I don't like the sound of the legal answers you are getting. I personally
"bill for services" when I work at the clinic on weekends.

The doctor must sign an agreement to accept what the insurance will pay.
This is know as 'assignment.' You are simply caught up in the little rules
surrounding 'assignment'.

The Chiropractor may not bill the auto insurance AND the health insurance.
Therefore chiropractor has billed the auto insurance excessively, and then
for the unpaid balance tried to bill the health insurance, and the unpaid
balance to you, and.... get it?

THE IMPORTANT PART is HERE:

He may not bill the health insurance without sending a letter to YOU for the
unpaid balance that the auto policy did not pay. In other words he had to
generate that letter even though he KNEW you weren't going to pay it!

DON'T PAY it.

Don't hire a lawyer. They cannot tell you not to pay it.

Take the bill to your Chiropractor and talk to him in private. He's already
been over paid and he knows it.

Do not pay anyone to fix this for you.... they can't. YOU must take that
bill and talk to the chiropractor yourself 'in private'

I'm a licensed MD, I've had a chiropractor on staff before.... they are more
trouble than they are worth :-)

Send me an email to [email protected] with arrangements to pay half the balance
on direct deposit through PayPal for this fabulous advise.

Rete

I reread the OP original post and there is NOTHING in there that says his private medical and his auto insurance both paid the doctor. So why this post?

Rete