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Auto Insurance Claims/Partial Medical Bill Payment Liability

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Expert: - 12/21/2008


Question
Bills were submitted to insurance by the chiropractic doctor totaling about $4000 for medical care following the auto accident. Prior to that incident we had paid him cash for regular treatments in advance. These same treatments would have only cost us about $1500.

The insurance company also thought his rates a little high and submitted remittance to them in total about $3000.  Now he is pursuing us for the balance (about $1000.)  Do they have a legal right to pursue the patient for the balance?

Note: We have already paid for all treatments beyond the scope of dates submitted to and remitted by insurance. The question is specifically about pursing the patient when the insurance makes a short payment of a long charge.

In the case of general medical insurance (such as dental) the doctor has agreed to accept the amount insurance submits as remittance. If the chiropractic doctor cashes the insurance check showing partial payments for the period from xxx to yyy can they pursue the patient for the "unpaid balance?"  

Answer
Hi Ethan.  This places you in a tough spot.  Yes, the chiro can do this and they normally make you sign something in advance of the treatment that allows this.

However, the insurance company should be able to provide some protection to you.  Call the adjuster and explain the problem and ask what they will do to help you.  If you do not like thier answer, ask for the supervisor.  They may be correct that the charges are not reasonable, but they need to prove this to the chiro and defend their position in court if necessary.

Auto Insurance Claims

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Claims Guy

Expertise

I am currently an Auto Claims Manager for a large insurance company. I have 18 years experience in the industry, having worked as a Claims Adjuster, Injury Settlement Negotiator, Claims Manager, SIU/Fraud Investigator, and Compliance Officer......I can answer questions related to any aspect of Automobile insurance claims and coverages. I can provide an inside look at how insurers operate. I always treat my customers fairly and want to help make sure you are treated fairly. However, please keep in mind that being treated fairly according to the law does not guarantee that you will get what you want. I can also answer some questions regarding Homeowner's and other types of insurance claims. I have handled all types of auto insurance claims and coverages. I am NOT an automotive repair expert but can give advice re how insurers handle complex repair issues. Please keep in mind that every state has its own set of laws pertaining to rules of the road, liability, and insurance. No one is an expert on every state. I am most familiar with laws in Maryland, DC, West Virginia, and Virginia, but will attempt to answer questions for other states. I am not an attorney an cannot provide legal advice. My advice will be my opinion based on my experience.

Experience

I am currently an Auto Claims Manager for a large insurance company. I have 18 years experience in the industry, having worked as a Claims Adjuster, Injury Settlement Negotiator, Claims Manager, SIU/Fraud Investigator, and Compliance Officer. I am not an attorney an cannot provide legal advice. My advice will be my opinion based on my experience.

Organizations
CPCU Society. Adjusters license in multiple states. International Association of Specal Investigators

Education/Credentials
I have a B.S. in Finance and have completed the AIC and CPCU designations.

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