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I am a healthcare provider and need someone to clarify a billing

Resolved Question:

I am a healthcare provider and need someone to clarify a billing issue regarding no-fault coverage in New York State.
Submitted: 1 year ago.
Category: Personal Injury Law
Expert:  TexLaw replied 1 year ago.
Hi,

Thank you for your question.

What is your billing issue specifically?
Customer: replied 1 year 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?

Expert:  TexLaw replied 1 year ago.
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 1 year 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.

Expert:  TexLaw replied 1 year ago.

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 1 year 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.

Expert:  TexLaw replied 1 year ago.
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.
Expert:  Infolawyer replied 1 year ago.
NY attorney here. What can I clarify for you?
Customer: replied 1 year ago.

Are you versed in new state no-fault law?


I've already had one expert who was not.

Expert:  Infolawyer replied 1 year ago.
Yes, kindly spell out for me what I can answer in that regard.
Customer: replied 1 year 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

Expert:  Infolawyer replied 1 year ago.
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
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