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Dimitry K., Esq.
Dimitry K., Esq., Attorney
Category: Legal
Satisfied Customers: 41221
Experience:  Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
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I had a revision rhinoplasty 2 years ago and my insurance company

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I had a revision rhinoplasty 2 years ago and my insurance company at that time approved and paid for half of the surgery. One year later the insurance company contacts the doctor and said they made a mistake and then denied the claim and said they want their money back from the doctor. The doctor is asking me to pay the insurance company back now since they received the payment from the doctor and then the doctor paid me the money and I applied it to the total bill.

This is the catch, the insurance company that initially paid for the claim was bought out by another insurance company. When I contacted the current insurance company they transfered me to a department that was handeling what was left from the bought out insurance company and I was told that I may not have to pay the money back because it has been 2 years and they are telling clients they have closed out the old claims from the old insurance company. However, my doctor is still getting calls from their claims department saying they need to pay them back.

Given the situation, do I have to pay the money back?
Thank you for your question.

To answer your question directly, under California law you are bound by the debt for 2 years if the contract and obligation to pay back was oral in nature. If the obligation was in writing (as likely this one was), you have 4 under statute to be pursued for the value. In that case you would remain liable for the debt UNLESS you can get the insurance company to send you a formal letter stating that they are waiving that obligation for you.

Hope that helps.

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Customer: replied 5 years ago.
Since the insurance company is asking the doctor for the money back and not me, then the doctor is currently held responsible and not me, right? So the doctor will have to pay them back and then bill me, right?
Thank you for your follow-up, Amber.

Yes, that is correct, the doctor would have to fight with the insurance company, and then the doctor would pursue you for anything the insurance company takes back. Most medical agreements for service have clauses that if personal insurance does not cover the procedure, the patient agrees to be liable for the costs. If you signed such an agreement before the doctor performed the procedure, it would be governed under the 4 year rule, and would permit the doctor to pursue you for the difference owed.

Good luck.