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JB Umphrey
JB Umphrey, Attorney
Category: Legal
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Experience:  Explains legal matters based on 14+ years experience.
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Customer Question

My doctor ordered a Stress Test and Echocardiogram from Heart Hospital, Insurance approved those two tests. Heart Hospital run the two tests plus two other very expensive tests. As I had never had these tests run before I was unaware that all the procedures run were not part of the Stress and Echo. I had talked to Heart Hospital about extra tests and they said it would be reviewed by auditor. I had not heard any thing back until I got notification that I am being sued by Bill Collector for the price of the extra tests. Am I liable for the payment of the extra tests
Submitted: 1 year ago.
Category: Legal
Expert:  JB Umphrey replied 1 year ago.
Welcome and thank you for your question!

I am sorry to learn of these circumstances. Am I correct to assume that insurance did not cover them? If not, why not?
Customer: replied 1 year ago.

They were not preApproved so only covered at a very nominal rate.

Expert:  JB Umphrey replied 1 year ago.
Okay, thank you. And, do you recall if you signed any paperwork when you started there that said you agreed to be financially responsible for any bills that were not covered by insurance? This is a standard form that's issued in most hospitals, clinics, doctor offices, etc. Did you sign such a form?
Customer: replied 1 year ago.


Yes

Expert:  JB Umphrey replied 1 year ago.
Thank you. Then, under the collective facts you've described, you are responsible for those costs.

In a different way, it's like if you were to go to a restaurant and ordered a $5 burger and the waitress asked you what kind of fries you wanted only to later get your bill and see that fries did not automatically come with the burger. Are you still responsible for paying for the $2 fries, too? Yes, you are.

In the situation you've described, you signed a document saying that you would pay for what was not covered by insurance. Thus, you are on the hook. If you don't pay, they can sue for breach of contract.

I know that this is not what you wanted to hear but you deserve a candid answer. I wish very much that I could offer you an answer that was more favorable to your circumstances, but the law seems to be pretty clear. Had I been able to provide an Answer which might have given you a successful outcome, it would have been my pleasure to do so.

I hope you understand.

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back. I am happy to address follow-up questions. Thank you for your business!

~~ J.B.
Customer: replied 1 year ago.


So they are allowed to run tests that are not requested by the Doctor and I am liable for anything they do. I signed for a Stress Test and Echocardiogram, not everything else. They were done outside of the Doctors request.

Expert:  JB Umphrey replied 1 year ago.
You are free to notify them, in writing, that you did not authorize those tests to be performed and, when they sue you in court, you can go to court and explain to the judge that you did not authorize that those tests be performed.

~~ J.B.
Expert:  JB Umphrey replied 1 year ago.
I see where you read my answer but not where you asked a follow up question or rated my effort to assist you with the law as it relates to your issue. The Site has been having some major systems issues recently so we are not always receiving customer replies or ratings.

If you do have a follow up for me, if you could send it again and let me know this is your second try (so I can let the Site administrators know), I would appreciate it.

Otherwise, if I have answered all of your questions, please take brief moment to rate my assistance to you so that I can receive credit for my work.

Thank you in advance.

~~ J.B.
Customer: replied 1 year ago.


I find fault with your logic. If I was to take my car to a mechanic for an oil change and he then replaced my tires along with the oil, with your logic I would be forced to pay for the tires even though they were not requested.

Expert:  JB Umphrey replied 1 year ago.
I understand your frustration. Please understand that, to a significant degree, that authorization form you earlier signed is their permission. That is their argument. Their approach will be that: you went there for treatment and agreed to pay for the care that was not covered by insurance. If they offered care that you did not approve, you would have to refuse it at the time it was provided (e.g., refuse the test, assuming that you were of the physical ability to do so).

The car tire example isn't a good one because the mechanic can remove the tires and, thus, does not suffer any harm. The doctors cannot, however, "undue" a test that was already given.

I hope this helps to clarify things! However, again, you can go to court after the sue you and explain to the judge why you should not be responsible because you did not agree to such testing. You will have to explain to the judge how you told them that you did not agree to it and they did it anyway.

~~ J.B.
Customer: replied 1 year ago.


Again I find fault. At no point in the document that I signed does it authorize the testing facilty to conduct tests beyond those required by the physician. Also at no time did the testing facility inform me that there were extra tests being conducted beyond the ones requested by the doctor. So with what you havbe been saying they can run any tests they want, irregardless of the doctors orders, not inform me and I have to pay for them.

Expert:  JB Umphrey replied 1 year ago.
Please understand that I am not acting as a judge in your matter. I understand your position perfectly. And, if they choose to sue you, that is the defense/argument you would make with the judge during the course of the lawsuit. You are entitled to raise that defense with the judge. Your position/argument is one that is to be made to a judge when/if they choose to sue. There is nothing you can do, however, to prevent them from filing a suit.

I hope this helps to clarify the context of things. If not, please let me know!

~~ J.B.

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JB Umphrey
JB Umphrey
Attorney & Counselor
10010 Satisfied Customers
Explains legal matters based on 14+ years experience.