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Dwayne B.
Dwayne B., Lawyer
Category: Consumer Protection Law
Satisfied Customers: 33555
Experience:  Practicing for over 20 years and handled many cases and trials for consumers.
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I had an operation 9-14-12. my primary insurance paid its

Customer Question

I had an operation 9-14-12. my primary insurance paid its portion and then it was turned over to my secondary insurance. my secondary insurance did not pay because they said that billing was coding it in wrong. I contacted billing and told them they needed to resubmit it with the right code. I called them 3 different times about this bill. I did not hear from them again and forgot about the bill. In October of 2014 I received a letter stating that I had been turned into a collection agency .My insurance rep. and I were on a two way call with the collection agency trying to get them to resubmit the bill. We were told it had bean turned over to medical billing and they could not transfer the call or give us a number to call. the secondary insurance would have paid the bill in full at that time if we could have been given the right information as to billing .To day I received a notice from an other collection agency for the same bill. I told them that my secondary insurance would not pay after so many years have gone by. They said that I would have to pay the bill in full. I feel like I gave it my best effort to get this matter re solved. Do I have to pay this bill.
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Customer: Is any one there?
JA: What state is this in? And when did the issue begin?
Customer: Idaho. It began in 2012
JA: Has anything been filed or reported?
Customer: What do you mean by filled or reported?
JA: Anything else you want the lawyer to know before I connect you?
Customer: Not at this time.
Submitted: 11 months ago.
Category: Consumer Protection Law
Expert:  Dwayne B. replied 11 months ago.

Hello and thank you for contacting us. This is Dwayne B. and I’m an expert here and looking forward to helping you today.

Assuming that you filled out the same papers as everyone else fills out when they go i for treatment then unfortunately, yes, you would still owe for the bill. In every set of papers you sign at a medical provider's office it states that you agree to pay the bill regardless of what your insurance company does. You would have a potential lawsuit against the medical provider and the insurance company for breach of contract, but until that time you still owe for the services provided.

You can sue for your damages plus your attorney's fees plus you can ask for an injunction from the court ordering them to remove any derogatory information from your credit report.

You're going to want to use an attorney for this because all aspects of this lawsuit are complicated.

As an example, the steps to an injunction are:

1) An Application for TRO (Temporary Restraining Order) is filed along with supporting evidence such as affidavits. Usually the Application for Injunction is made at the same time. The TRO is a temporary measure and is not absolutely required before you get an injunction.
2) An Ex Parte (without the other side present) Hearing is conducted and the judge either issues the TRO or denies it. If the TRO is issued the judge orders a bond set in a sufficient amount to compensate the other side for any damages accumulated while the TRO is in place if the applicant fails to prove their right to an injunction.
3) A hearing on the TRO is set.
4) The TRO and notice of Hearing is served on the defendant.
5) The defendant should immediately begin following the judge's orders.
6) The TRO hearing is held and each side has an opportunity to present evidence and question witnesses.
7) The judge makes the decision on whether to convert the TRO to a Temporary Injunction or not.
8) If the TRO is converted to a Temporary Injunction then the judge sets a new bond to be in place.
9) Discovery is conducted by both sides.
10) A request for hearing date is made on the matter of converting the Temporary Injunction into a Permanent Injunction.
11) The hearing/trial is held on the Permanent Injunction and the judge issues a ruling.

These are what are known as extraordinary remedies and the procedural rules for these as well as the case law are EXTREMELY specific and difficult. If ANY mistakes are made the judge has no choice but to deny the relief and will not likely reconsider it in the future.

Just as an example, getting injunctive relief, both temporary and permanent, requires that evidence be offered of:
1) An immediate need,
2) Which, if not granted, will result in irreparable harm,
3) With no adequate remedy at law, and
4) (on temporary order) The person requesting the injunction is likely to succeed at a full trial on the merits.

If evidence is not offered to meet these four requirements, in a manner that the judge knows this is what the evidence shows, then the petition will be denied.

There are more requirements than this depending on the exact facts of the case but it is very, very easy to mess up one of these and end up having to pay damages to the other side just because your paperwork wasn't done properly.

You may also be able to get punitive damages because I think it is likely you will get "bad faith damages" against the medical provider or the insurance company for what they are putting you through. Many times these bad faith damages are triple the actual damages.

If your question has been answered then I'd offer my best wishes to you and ask that you please not forget to leave a Positive Rating so I receive credit for my work. Of course, please feel free to ask any follow up questions in this thread. I want to be sure that all of your questions are answered.