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Maverick, Lawyer
Category: Consumer Protection Law
Satisfied Customers: 5751
Experience:  20 years of proefessional experience
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Getting medical bills for something that should have been

Customer Question

getting medical bills for something that should have been covered. The insurance company initially paid and then requested a refund so now I'm supposedly responsible for the bills. What do I do? I keep getting different answers from the insurance company and the medical provider billing departments!
Submitted: 2 months ago.
Category: Consumer Protection Law
Expert:  Maverick replied 2 months ago.

Welcome! My name is Maverick. Please give me a few minutes to analyze and/or research your inquiry and I will be back.

Expert:  Maverick replied 2 months ago.

One way to handle this is to file suit against the insurance co. and the provider in what is known as a declaratory judgment action and ask for the court to decide which one of the two is correct in its position based on the contract you signed with the medical provider and the terms of the policy that covers you. This is done through what is known as a declaratory judgment action.

Another way is to hire a health insurance bad faith lawyer to sue the insurer. You may wish to consult with one as they may take your case on a 33% contingency fee basis. You can get a referral from your State Bar Association.

Customer: replied 2 months ago.
Thanks for this initial info. Is this very common? I'm from Canada and I've never run into this! Is a healthcare insurance advocate able to assist with this? (I don't have $ to spend on a lawyer)
Expert:  Maverick replied 2 months ago.

Yes, medical billing advocates can help also. Some charge hourly, at a rate of $100-$200. Others charge as a percentage of savings—usually 15%-35% of the price they got your total charges reduced by. If that does not work than you may want to locate a bad faith lawyer. By then you should have enough documentation to show that the insurance company is denying the claim purposefully.

Filing the declaratory judgment is not common but is effective because it forces them to have to hire and incur the cost of a lawyer to defend the action.

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