How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Maverick Your Own Question
Maverick, Lawyer
Category: Consumer Protection Law
Satisfied Customers: 6392
Experience:  20 years of proefessional experience
Type Your Consumer Protection Law Question Here...
Maverick is online now
A new question is answered every 9 seconds

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: 1 year ago.
Category: Consumer Protection Law
Expert:  Maverick replied 1 year 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 1 year 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 1 year 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 1 year 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.