Expert: Regan Shinski - 1/7/2010

Question
My boyfriend was treated in a hospital this past summer and his condition require minor surgery.  While he was in hospital, we checked with his insurance company and they informed us that after a small deductible, which he paid after his treatment, he was completely covered for all services. At no time did he sign anything stating he would pay any charges beyond his insurance allotments.  He has been repeatedly billed by and anesthesiologist who treated him during the surgery, despite the doctor's having been paid by his insurance company.  The insurance company has also sent him 2 cease and desist letters.  He has now sent my boyfriend's bill to a collection agency.  My boyfriend has copies of all the correspondence and all his bills.  What can he do to stop this?

Answer
Hi Jessica:

A cease and desist is probably not applicable with the anesthesiologist.  Cease and desists generally are only applicable with third-party collection companies under the FDCPA or through a court order in cases like this.  BTW, a cease and desist does not stop them from pursuing through courts or filing with a collection agency.  It basically only says "stop communicating with me."

Medical cases are difficult.  I believe it is unusual for a patient not to be liable for treatment they received.  Usually in the admitting papers there is a general clause that covers "reasonable" or "necessary" treatment.  There are also state laws that may bind a person financially (there are also some that help)  Regardless, this does not mean he doesn't have recourse through the insurance company or other options, I'm just saying he is the one that received treatment, so the ho.  You may want to double check ALL documents to see what he signed.

I'm a little confused by your statement "He has been repeatedly billed by and anesthesiologist who treated him during the surgery, despite the doctor's having been paid by his insurance company."  Are you saying the doctor that was paid was this anesthesiologist or the other doctors at the hospital?  Most doctors work independently and separately bill.  If this is a case where this doctor was paid and he is still collecting, you just need to get proof of the payment and get it to the collection agency.

More than likely, this will become a dispute between you and the insurance company.  What are they saying?  Why haven't they paid it if they claim all treatment was covered?

If this doctor has been paid, the problem and dispute is with them.  Get the proof of payment to them and their collection agency.  If they haven't been paid, you need to work through the insurance company to find out why and get them to pay it.

Good luck.  I wish I had better news or options for you.

Regan