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Richard, Attorney
Category: Legal
Satisfied Customers: 55607
Experience:  Attorney with 29 years of experience.
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My physician has a contractual payment arrangement with my

Customer Question

My physician has a contractual payment arrangement with my health care provider. I ask when scheduling my annual physical appointment what my portion would be and I was told zero based on my insurance. My insurance coverage had a zero deductible and a zero co pay on preventative health care. When I left the office after the appointment I was again told I owed nothing. Once my provider payed the bill, they payed $94.00 and my physician is attempting to collect $154.00 from me. They state it that the contractual payment from Aetna and then state the benefit maximum was exceeded. It is not listed as a copay, a co insurance or deductible. I consider this to be balance billing, which is not permitted, correct?
Submitted: 1 year ago.
Category: Legal
Expert:  Richard replied 1 year ago.

Good morning Sherri. My name is ***** ***** I will be helping you today! It will take me just a few minutes to type a response to your question. Thanks for your patience!

Expert:  Richard replied 1 year ago.

Your physician is not going to be able to collect this. You had every right to rely upon the physician's assurance that you would owe nothing. It was their duty to inform you, after checking your insurance coverage, of any charge you would owe. They told you nothing. If there was an error, then the risk of loss is on them not you. You did everything you were supposed to do and now they are trying to collect an excess amount to which they are not entitled. You want to stand up to them on this as too often these folks in medical offices just try to shove these charges down your throat and too often get away with it. They would not prevail in any claim against you in trying to collect this.

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