Expert: Regan Shinski - 6/2/2010

Question
A specialist intentionally lied to me and provided me with mis-information on being an in-network provider with my insurance company. I had diagnostic procedures done and then a few months later received a large bill for the amount remaining. They have a 3rd party billing company who told me they were out of network and thus why the amount was higher. I told them I would pay in-network amounts since that what was told to me. Now they have sent me to a collection agency who has raised the balance by $350.00 with no explanation. I have disputed the charge with this third party collection agency. What is my recourse here? I spoke to my insurance company who told me that if they were in-network I would have nothing to pay. He was referred by a doctor I trust so I did not question when they said they would be in network. What is my recourse here against the doctor, the third party billing company who never returned my calls and now this collection agency?

Answer
Hi Elizabeth:

Your recourse is against all of them by all means possible.  I would add the doctor you trusted who made the referral.  He's likely not legally liable for monetary damages but you can call his office, advise them what happened, and state you are upset and state that he should stop referring his patients to such unethical practitioners.

Your best recourse is literally to file a lawsuit.  It sounds more complicated than it is, but you file a suit against the doctor and collection agency and probably the billing company as well.  If you have evidence (testimony, papers, etc.# proving your case, the file should be deleted and you should collect monetary damages including attorney fees if applicable.

A less direct route is to start the complaints.  Complain everywhere:  Better Business Bureau,  Attorney General's office, American Medical Association, and ANY other trade or licensing bureau this doctor AND collection agency belong to.  Include a brief history and send in any documentary evidence you have.  This often gets the job done.

A third option is to tackle through credit repair.  It's a more legal and thorough method but can be used if the method above does not work and before filing a lawsuit.  Often it can beef up your lawsuit as well.  Feel free to contact me again if the above method#s) don't work to get more details.  It actually may be a little premature at this point for you.

Good luck, I hope this helps.

Regan