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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 88349
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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I was hospitalized at Baylor University Medical Center in Dallas,

Resolved Question:

I was hospitalized at Baylor University Medical Center in Dallas, Texas and Aetna my health insurance carrier paid most of my bill and I paid my co-pay of $603.80. So I have zero balance on my bill.I applied for Personal Injury Protection on my car insurance which is $5,000.00 because my hospitallization was due to falling from my car when I was getting out of my SUV. Safeco Insurance, my car insurance carrier paid the $5,000.00 to Baylor even after I told the Safeco claim adjuster that I have zero balance on my bill. Baylor refused to refund me the money and they kept the $5,000.00. I filed a complaint with Texas Dept. of Insurance against Safeco. Baylor Business Services claimed that they refunded to me the $603.80 which I never received. Safeco got back from Baylor $4,396.20 and now Baylor billed me this $4,396.20. I want to file a complaint against Baylor for unfair billing practices. Can you help?
Submitted: 1 year ago.
Category: Legal
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question I look forward to working with you to provide you the information you are seeking.

Actually, if your PIP paid for an injury that your primary health insurance paid for, then under Aetna's right to subrogation they are actually entitled to reimbursement for anything they paid that was covered by some other insurance. It sounds here like Baylor's billing is now very confused, since Aetna paid them already and you should have received the $600 and the remainder should have gone to Aetna and not Safeco under Aetna's right to subrogation.

You can notify Aetna, as they have a right here to reimbursement. Your other recourse is suing Baylor for breach of contract and negligence for improperly handling the insurance funds. Generally, Aetna will step in and go after Baylor and Safeco to get the money back and to straighten out the bill, since Aetna already paid what Baylor is now claiming you owe. If Aetna will not step in, then you would have to file suit in the small claims court against Baylor for improperly handling the insurance funds in breach of contract and negligence.



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Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 88349
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
Law Educator, Esq. and 12 other Legal Specialists are ready to help you
Customer: replied 1 year ago.

The money should have been sent to me because I was out on sick leave for almost a month without salary and that $5,000.00 was for lost wages which I am entitled to. I called several individuals at Baylor Business Services trying to get the $5,000.00 and they told me it was their manager who decided to keep the money. I also tried to talk to the manager and she refused to even talk to me.

Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your response.

At this point, you are going to have to file suit against Baylor for breach of contract and negligence to get your money returned since they are the ones who have made a mess of this through their improper actions and they refuse to communicate with you on this matter.

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