Doctor sending me a bill on PI case after 4 years

[graci]

What is the name of your state (only U.S. law)? Maryland

I just settled my PI case about 2 months ago and my lawyer said they have to call each medical provider to confirm that there are no more balances. My lawyer called my physical therapist asked her if there was a balance. She asked my lawyer to send her any EOBs that were paid by my insurance company so so she can confirm if there is a remaining balance. My lawyer faxed the copy of all medical claims that she had made to my insurance company (for about 16 visits). After that we tried contacting her and she would not return any calls. After waiting for a month my lawyer had me sign a statement in my final disbursement letter that they were not able to contact her and I would be responsible if she bills me for anything after that.
I received a bill from my physical therapist that my insurance has paid for 16 visits but there are 15 unpaid visits for a total of $3400 and that if I don't pay in full within a month there will be a legal action. I think she is just making that up and filling in any gaps for the time I did not go for the physical therapy. I have left her a message to send me an itemized bill with dates of service but am not sure if I will hear back from her.
What are my options?What is the name of your state (only U.S. law)?

 

[ecmst12]

Find out the dates of service and see if they match up with bills sent to your insurance company. Is there a reason they would not pay for half your visits? Your lawyer should have a record of how many visits you had as well. Did you have appointments that you no-showed?

 

[graci]

I already the spreadsheet from my insurance company claims and the only claims that were submitted but not paid were the duplicate claims. All the other claims that were submitted were paid. I never had any no shows. She is an individual practitioner and I think she is just trying to make money from anything she can.
She already has the dates of service that were paid by my insurance company (my lawyer faxed it to her)...now she is trying to make up the dates and show that I owe some money to her.

 

[aldaron]

OP you should have never signed that release from the attorney till all bills were settled. Another thing is usually when attorneys and insurance are negotiating those bills they're usually less costly than when joe blow gets billed.

 

[graci]

I mean how can someone just send me bills after 4 years. Can anyone just send me a medical bill stating that I rendered their services when I really did not?

 

[ecmst12]

I would send her a letter stating simply that the records from your insurance company, your lawyer, and your own records show that you received treatment on X days only and that she has been paid for all dates, and no further amount should be owed. Send it certified and leave it at that.

 

[graci]

Thanks ecmst12...I think that's what I am going to do...but it just is scary and frustrating at the same time.

 

[justalayman]

Thanks ecmst12...I think that's what I am going to do...but it just is scary and frustrating at the same time.

this is a bit of a side track concerning this but:

is your insurance a PPO? Is the provider a signatory provider?

 

[graci]

Yes my insurance is PPO and the provide is 'in network' with the insurance.

 

[aldaron]

You need to ask this DR to privide her proof of services rendered on dates not jiving with your records and ins, get to the meat of the problemo.

 

[justalayman]

Yes my insurance is PPO and the provide is 'in network' with the insurance.

You might try contacting your insurance company. The providers and the insurance companies have contracts between them regarding the providers actions towards a patient. . Due to the lawsuit, I do not know how all of the billings and such have been handled but the insurance provider may be able to advocate on your behalf, especially if this involves double billing.

 

[graci]

She actually stated last time that she billed my insurance company for some visits and she did not for some visits. Since she cannot go back to the insurance company since my insurance company won't accept the claim that old she wants me to pay for it.

I did try contacting the insurance company yesterday and they stated that I'd be responsible if the provider did not bill the insurance company and that I should have been proactive and looked at the claim and made sure that the claims were submitted.

 

[swalsh411]

Oh well that is just bullcrud. You are not responsible for a bill because the provider failed to bill the insurance company, especially 4 years later. Yes in general you should be on top of what services you are receiving, co-pays, and what the insurance is being billed but you are absolutely not required to make sure you had 19 visits over 15 months and confirm the insurance company was billed for 19 visits. The provider dropped the ball, not you.

 

[ecmst12]

If she's contracted with your insurance company and failed to bill them in a timely manner then you are NOT responsible for the bill. If she wasn't contracted it would be different. But I think you'd remember, even all this time later, having twice as many visits as she originally billed for.

 

[graci]

Thanks for all the support....You know what...I was just going through all the documents and the bills and I found one bill that she submitted to my insurance company (and my med insurance actually paid for it) for a date of service when I was not even in town...I can actually prove that...
But I am not sure if that would take any liability off me