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JB Umphrey
JB Umphrey, Attorney
Category: Legal
Satisfied Customers: 20233
Experience:  Explains legal matters based on 14+ years experience.
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My daughter got her immunizations at healthcare clinic in Oct

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My daughter got her immunizations at healthcare clinic in Oct of 2011. They didn't submit it to my insurance until Dec of 2012. My insurance declined it saying it wasn't submitted soon enough and now the clinic is sending the bill to me for entire amount. I'm not willing to pay for something that my insurance would have paid in full if they would have submitted it in a timely manner. Am I responsible for this bill?
Welcome and thank you for your question!

I am sorry to learn of the facts you've described. Can you please clarify: did the clinic accepts your kind of insurance at the time of October 2011?

Why didn't they submit the billing in a timely fashion?
Customer: replied 4 years ago.

Yes my insurance was accepted by the clinic. It wasn't the first visit to the clinic that she had, and they have paid all other visits that were billed properly.
I don't know why it took them so long to submit. My insurance never changed, and it wasn't the first visit there with that insurance.

Thank you. On a separate matter, had you signed a form with them that said -- what insurance doesn't pay, you agree to pay?
Customer: replied 4 years ago.

I don't know if I did or not. I signed something before the appointment but it was a long time ago. I'm assuming that you always sign that before a Dr's appointment but I don't know.

Right, it's a pretty safe assumption to make.

There are two parts to your answer. Could they try to sue for breach of contract for the non-payment? Yes.

Importantly, however, do you have a defense that you could assert in court? Yes. The defense would be that they breached their fiduciary responsibility to timely submit the bill to insurance and, thus, they are the cause of their own loss. That is the defense you would make to the judge if they try to sue you over it.

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back. I am happy to address follow-up questions. Thank you for your business!

~~ J.B.
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