What is the duty of a medical office to properly bill one&#39;s insurance? (USA) In the US, it is typical for patients to sign contracts with a medical office assigning whatever benefits are applicable from their health insurance to the doctor's office and leaving the patient financially responsible for what is left unpaid. Is there a minimum standard for doctor's offices to actually complete the insurance process before passing on the rest of the bill, and if so, what kind of remedy is available if they don't? Example: A doctor's office sends to the insurance company details of a procedure to be paid, but left off one fact that the insurance company needed to complete the claim. The insurance company informs the doctor's office that in order to finish the claim, they have to complete the missing bit of paperwork. Instead of doing so, the doctor's office leaves benefits the client is entitled to unclaimed and proceeds to bill the patient for the unpaid amount. Is this a valid bill under that standard kind of contract? Is there some kind of minimum due diligence required on the doctor's part, and if so, is there some area of tort law that is available for redress?
To my knowledge there is no actual law requiring a provider to file anything on your behalf. Most do it as a courtesy but if you read the terms of service that you almost certainly agreed to, it will say that YOU are the responsible party. If the insurance company doesn't pay, even if the provider doesn't submit a claim, the responsibility is still yours. There is nothing stopping you from filing your own claim using whatever forms or procedures that they have established. I'll also note that many provider networks have rules that providers must adhere to in order to remain in that network. Some may include language about timely filing of claims but that is in no way universal. These days many providers have taken to billing the patient the full amount immediately and then will issue a refund to you if/when the insurance pays.
There aren't any specific laws or regulations about medical charges. Instead, this is a matter of general contract law, where you have to agree. You have to consent to be treated, and a signature is taken to be evidence of consent. The law does not say that they have to ask permission for absolutely everything they do, the action just as to be in accordance with an accepted standard of medical practice among members of the medical profession with similar training and experience in the same or similar medical community as that of the person treating, examining, or operating on the patient for whom the consent is obtained This law insulates doctors from getting sued. In a situation where treatment is provided against a patient's instructions, you may have a cause of action for e.g. battery. In general, a doctor can't poke you, draw blood, make "offensive contact" etc. without consent, and consenting to one procedure does not "open the floodgates" of consent for any othre procedure. Of course, if the procedure was not performed, you obviously are not liable for the cost (and they are not liable for a non-occurring battery). This may in fact constitute gross negligence. During trial, the primary issue is likely to be whether there is proof that the procedure was expressly rejected. The doctor would probably provide the consent form, and that form may or may not indicate that the test would be conducted. It would not be surprising if the patient never saw an actual form and instead just electro-signed, having been told that this is authorization to treat. Corroborating witnesses would be helpful. From a practical perspective, especially if the billing department is being recalcitrant, this is probably a matter best handled by an attorney who would start with a formal letter summarizing the consequences of unauthorized medical treatment.
Dead people have to pay their debts just like everybody else It is one of the primary roles of the executor to make sure this happens. Dead people can dispute a debt just like everybody else Just because someone says you owe them money, that doesn't mean you owe them money. In fact, the onus of proving the debt lies with the person claiming the money. It is perfectly reasonable for an executor to ask the creditor to do so. Some questions that are appropriate to ask: Presumably, the entitlement arises under a contract; when was the contract entered into? What were its terms? Where is the evidence the deceased agreed to these terms? Do the terms comply with (consumer) law? Have the prices been calculated in accordance with the terms? Have previous invoices been submitted and paid on the same basis? All the issues you mentioned. These are all things the creditor would need to prove if they went to court. If they can provide satisfactory answers to these then pay the bill. If they can't then try to agree to a settlement amount acceptable to both parties. If you can't do that, let them sue the estate and let a judge decide. The debts of the deceased person are payable by the estate of the deceased person for which the executor is the trustee. The executor has a duty to the beneficiaries of the estate to act in their best interest. This means paying bills that they are satisfied are justified, contesting those that aren't but ultimately, making commercial decisions that benefit the beneficiaries. Getting bogged down in a court case may not be in their best interest especially if it delays finalisation of the estate. In any event, the executor is not liable personally for the debt, or for anything they do or fail to do if done or not done in good faith.
Parents have a legal obligation to care for their minor children: it is illegal to harm a child through action or inaction. State law and associated welfare programs are complex: you can start here. If surgery is medically necessary, her insurance should cover it. If her parent do not have medical insurance, they still have the obligation of care; though various governmental programs may alleviate the problem, such as the state medical assistance program. The parents may therefore be in violation of the law, and anyone may report this to DSHS (specifically through Child Protective Services). This obligation terminates when the child turns 18 (assuming that someone does not petition for adult guardianship). Legislation is not crystal clear as far as what constitutes "injury of a child ...under circumstances which cause harm to the child's health". CPS has no authority to compel parents to pay for a medical treatment, but they can go to the courts on behalf of the child. At that point, it's hard to say what the court would order. For example, if the parents are capable of providing medical insurance and just willfully chose to not cover their child, the court could order them to get insurance. It is virtually guaranteed that the courts would not order the immediate amputation of the child's feet, and there would be no legal basis for ordering the parents to pay for the procedure in a decade, after the child is an adult. However, if you are suggesting that there is an immediate treatment (which the parents have opted to not provide, hence the prospects of later amputation), then it is reasonably likely that the courts would order the parents to provide for the treatment (if it would be possible for them; otherwise, the state may intervene and provide for the treatment).
Employers with 20 or more full-time-equivalent employees are usually mandated to offer COBRA coverage. https://www.investopedia.com/articles/insurance/11/intro-cobra-health-insurance.asp He is not required by law to offer it to you, but is probably trying to work with you. After employment, the individual is required to pay the entire premium, and at times it may be topped up with an extra 2% toward administrative charges. They can charge you administrative fees on top of what you would have paid. Being that he does not have to offer it to you by law, he can do what he wants.
The contract remains valid. Most contracts don't need to be written at all. Even if yours did need to be written under the Statute of Frauds or some other law, you're saying that it was made in writing, even though you later tore it up. The fact that the contract is missing or destroyed doesn't change the fact that it exists and obligates the parties; it just makes it harder to prove what it said.
It is legal for a doctor to charge for each procedure that they perform, so if it is necessary to remove more teeth, the doctor can charge for that additional removal. A patient may not fully understand what the scope of their contract with the dentist is, thus one might think that they have paid $18K for a &quot;complete solution&quot;, irrespective of what has to be done. More likely, the contract is for specific work, and if more work needs to be done, more money has to be paid. When a doctor (mechanic, contractor, lawyer...) gives you a ballpark figure for likely costs given their understanding of the work probably required – based on current knowledge – you should understand that as an estimate, which may be inaccurate given new discoveries. Of course, if a person knowingly and deliberately misrepresents the scope of work required, in order to persuade the customer to sign on with their service, that is probably legally actionable. If you can prove that the doctor actually knew that the scope of work was greater than what he claimed, you could have a legal case. Otherwise, you have the option of taking your business elsewhere, or paying the additional charges.
A Lawyer may hire paralegals, clerks, secretaries, and other assistants. The lawyer may hire as many as s/he pleases, and assign them whatever tasks s/he chooses. However, some kinds of documents may need to be signed by the lawyer (which ones will depend on the jurisdiction, in the US on the state). During the so-called &quot;robo-signing scandal&quot; it was held that, in some US states at least, a lawyer who signs certain kinds of documents without reviewing them has failed to perform the duties imposed on the lawyer by the law, and the documents may be invalid. Large numbers of mortgage foreclosure cases were dismissed when it became known that the lawyer signing relevant documents had not in fact reviewed them (or in some cases had not even signed them, but had permitted a non-lawyer to sign the lawyer's name). In addition, some functions in some jurisdictions must be performed by an actual lawyer. For example, paralegals and other non-lawyers cannot validly give legal advice. Only a lawyer can represent a client in court. And so on. I question whether one lawyer could in most kinds of practice keep up with the work of &quot;hundreds&quot; of non-lawyers, but that would depend on the kind of work done by the firm. In the US, some law firms are essentially collection agencies. There a single lawyer with many many assistants suffices, I understand, and that structure is not uncommon in the US.