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Infolawyer
Infolawyer, Attorney
Category: Personal Injury Law
Satisfied Customers: 54240
Experience:  Licensed attorney helping individuals and businesses.
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I am a healthcare provider and need someone to clarify a billing

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I am a healthcare provider and need someone to clarify a billing issue regarding no-fault coverage in New York State.
Hi,

Thank you for your question.

What is your billing issue specifically?
Customer: replied 3 years ago.

I have received a denial for treatments I administered, Progressive is saying the condition patient is coming for is not caused by the original accident.


 


> Can I ask her to pay out of pocket moving forward?

Did you sign any agreement with her that you would only take payment from her personal injury policy?

Have you entered into any sort of Letter of Protection agreement with her attorney?
Customer: replied 3 years ago.

No, no agreements verbal or written at all.


 


I am asking because it is believed in my field that once a patient is covered by no fault, a provider cannot collect a cent from that patient.


Just to make sure that I'm on the same page with you:

When you say "no-fault" you are referring to the patient's insurance policy which provides personal injury coverage as part of an automobile policy?
Customer: replied 3 years ago.

It's the driver's automobile insurance policy which provides for personal injury, the patient is the injured pedestrian.


 


If you don't do no-fault, I will still pay you, but I probably need to consult someone else.


 


Let me know, thanks.

No need to pay me. I'm going to opt out here and see if anyone else at JustAnswer is familiar with this. I'm not aware of this type of insurance policy.

However, just to share my hunch, I would assume that if the insurer is denying coverage, then you can ask for payment from the patient.

I'll put this back up on the board for another expert.

Please don't respond as this will delay another expert picking up the question.
NY attorney here. What can I clarify for you?
Customer: replied 3 years ago.

Are you versed in new state no-fault law?


I've already had one expert who was not.

Yes, kindly spell out for me what I can answer in that regard.
Customer: replied 3 years ago.

Excellent!


 


I have been treating a patient who was hit by a driver. The driver's no-fault insurance i through Progressive. After 6 weeks, I have received a denial for the treatments I administered, Progressive is saying the condition the patient is coming for is not caused by the original accident.


 


 


 


> Can I ask her to pay out of pocket moving forward?


 


 


 


I have not entered into any written or verbal agreement with her or her attourney (not even aware if she has one) regarding billing... but I don't want to break the law if it is illegal to ask her to pay for future treatments.


 


Thanks,


Steve

Yes, you contractually and professionally are entitled to do so and should agree on pricing. If cannot agree, you may wish to discontinue the relationship.
Infolawyer, Attorney
Satisfied Customers: 54240
Experience: Licensed attorney helping individuals and businesses.
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