Expert: Doctor Settlement - 3/13/2007

Question
Hello,

I was involved in an accident in CA and it was the other driver's fault. I am dealing with his insurance company. I have a total of $4000 in medical bills for treatment and chiropractor visits.
The insurance company is having problems with my medical bills. They are saying that they are on the high end for the cost per visit, but they don't seem to have a problem with the number of visits. They are also stating that they won't pay a charge of $300 from the doctor for the writing up of his 5 page final report/summary/recap.

Can the insurance company refuse to pay the total bills from the doctor? Is this another tactic that they use to try and reduce their overall payouts and lower their pain and suffering payments?  I have looked and your website and believe this to be the case, but would like to confirm it. I don't want to be stuck with paying the remaining doctor bills balance that the insurance company is refusing to pay.

Thanks for your help.


Answer
Hi Joe,

Thanks for looking at www.SettlementCentral.Com for some tips on handling medical bills.  We may not have this information on the free side, I do not know.  But our choice in handling the payment of medical bills is spelled out for our members as follows:
#1 use your health insurance
#2 open your own PIP
#3 last choice, let the third party pay the bills.

The reason the third party is the last choice is just what you ran into here: they get to control the case and the course of treatment.  For example, if you had to return for treatment, then you would not get coverage from the adjuster.

Yes, the insurance company can allege that charges exceed "reasonable and necessary" for the injuries and the kind of treatments given.  So proof of those elements is always going to be your burden.

I would take this argument back to the doctor and let him respond.  After all, they are calling HIM out, not you.  Give him a look at the following pages to see if he can find any help in making up a counter argument.

As for the narrative report, why did he do it?  Did you ask for it?  Did the insurance adjuster ask for it?  Whoever asked for it should pay.

Well, what if he just did it on his own.  In truth you could end up stiffing him for it, but in truth it will likely help you increase the value of your claim a lot more than the $300 price tag.  So if you end up getting stuck with it, at least make your doctor respond to the adjuster's claim that the treatment costs are out of line.  Use the arguments I am going to give you on the secret pages below.

Here is a sneaky little reference for insurance adjuster letters on www.SettlementCentral.Com that you would not find on your own, inasmuch as we put it there mostly to aid chiropractors whose patients have been denied PIP payments.  But you can benefit by reading and using the same arguments.  

Here is the doctor's introductory page:
http://www.settlementcentral.com/page0070.htm

Look at all three examples.  Get some ideas from these pages.  The one that most closely resembles yours is this one:
http://www.settlementcentral.com/page0071.htm

I have given you some free letters there to fight back.

One other thing to do is to open your own PIP and make them pay the charges.  But it may be a bit late for that if the third party has been paying all along.


Best wishes,

Dr. Settlement, J.D. (Juris Doctor)
www.SettlementCentral.Com