Legal question re: medical charges?

Question

I saw a physical therapist for about 6 months and paid her $85/ week. Prior to my first session with her, I faxed her a copy of my insurance card. She called me back, stated she had received my fax and checked with my insurance, and that they would not cover her services, and that she was the only physical therapist in the area who specialized in pelvic floor rehab which was what I needed- so I would just have to pay her privately if I wanted the therapy. After I had paid her $85/ week for about 6 months, she told me that she had "accidentally" called the wrong insurance company- she had assumed that the employer I worked for still used "ABC" insurance as they had in the past, and had not even bothered to look at the card I faxed her- she simply called "ABC" insurance, found they wouldn't cover her services, and proceeded to charge me privately. She then told me that there was nothing she could do about the previous sessions that I had paid for privately-- I would just have to count my losses-- but that she had called my REAL insurance company and found that if she wrote them a letter, they would pay for any future sessions. I was so angry that I stopped seeing her at that point. I'm wondering if we can get the insurance to cover the sessions that I paid her for privately so that she can reimburse me, but this would involve her contacting them and writing them the letter, and she is avoiding me and refuses to return my ph calls.

This was a very emotional issue (involving intercourse pain) that I was seeking therapy for, and I was so desperate to resolve it that I dug myself into a financial hole paying for her service. Plus, she was unable to help me correct the problem anyway. I would like to get some money back now that I know that my insurance WOULD HAVE paid had she contacted the correct company to start with. Do I have any legal rights in this matter?

Answer 1

Call your insurance company and see what they say. If the physical therapist doesn't cooperate, warn her that you will go to the state licensing board (and you should file a complaint there eventually anyway). If you don't get anywhere with your insurance company, sue her in small claims court.

Answer 2

Yes. You collect a statement of billing from the therapist for the past 6 months and submit a claim with your new insurance company. Submit a letter detailing what you told us. If they deny, file an appeal.

Answer 3

DDorer is correct on this one. If your insurance company covers the kind of treatment the quack doctor gave you then you should still be able to file for reimbursement or at the very least have it contributed to your deductible.

Contrary to popular beliefs, insurance companies do try to help people but it takes a lot of time and effort due to legal complications. Get all of your statements from the physical therapist and call your insurance company to ensure that the services can be covered.

If they deny it, file an appeal.  

Answer 4

First, how tragic and unprofessional of this person.  

Second, $85 a week is a really good deal. (but I know that's no consolation)

Third, even if she won't return your calls, there's no reason you cannot submit the claim yourself. Ask for a claim form and send them the your receipts and charges.

Addendum: I wasn't trying to have an attitude, I was simply trying to tell you that compared to traditional charges for PT, this was much less than average.  A typical visit at our clinic is about $200.  And I wasn't trying to imply that I am overly wise, nor was it my intention to dismiss your feelings.  It was simply an observation and nothing more than that. I know sometimes it's difficult to understand one's message in an online post.

Sorry to hear it was not beneficial for you.  Sounds like this person gave you a raw deal from the beginning and I do not consider her actions representative of the profession....that's why I said I know it was no consolation. I do truely feel for your situation.

Please consider the answer as a whole before sharply lashing out at people. I hope you can get past your anger to see that I am trying to offer you some advice to help you reclaim your money.  I know it's a sucky situation, but I definetely think you can get your money back from insurance. And if the original message sounded condescending, please know that this was not my intention, and I do apologize.