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I am wondering, in the state of Oregon if it is illegal for…

Customer Question
I am wondering, in...

I am wondering, in the state of Oregon if it is illegal for a provider to not tell a patient that they are not covered through insurance and still collect a co-pay. Also to not tell a patient of a billing issue after 12 visits and 3 months after the last appointment?

Lawyer's Assistant: Has the patient talked to an Oregon lawyer about this?

No

Lawyer's Assistant: What steps has the patient taken so far?

None, just talked to insurance about coverage.

Lawyer's Assistant: Anything else you want the lawyer to know before I connect you?

The provider received my insurance coverage information. Failed to tell the patient they were not covered. Collected a copay and continued to see the patient for 13 visits. Now 4 months after the last visit they are asking for the amount not covered through insurance. The patient was never told or billed during the time being seen.

Submitted: 1 month ago.Category: Legal
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Answered in 8 minutes by:
3/14/2018
Lawyer: Law Educator, Esq., Attorney replied 1 month ago
Law Educator, Esq.
Category: Legal
Satisfied Customers: 123,240
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
Verified

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

I am afraid that under OR law and federal law, ultimately it is always the patient's responsibility to verify coverage and they cannot rely on statements of providers. If a patient received treatment and the patient and provider believed they were covered and the patient was not ultimately covered, the patient remains responsible for the bill. There is no statute that states what you suggest, that the patient would not be liable if the doctor collected co-pay and ultimately the insurance did not pay.

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Customer reply replied 1 month ago
Is there any law on when a provider is required to bill for a visit? And notify a patient if they have a bill?
Lawyer: Law Educator, Esq., Attorney replied 1 month ago

Thank you for your reply.

Under OR law, the provider can bill for visits anytime within the statute of limitations, which is 6 years. There is no law though requiring the doctor provide a bill each visit.

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