Rhode Island Personal Injury Lawyer
by Slepkow Law
Rhode Island Doctor Balance Billing
Balance billing

If someone goes and sees their doctor because they are sick or they fell over their own feet causing injury, they usually expect to pay their bill via their medical insurance plan. The patient pays the co-payment required by their health insurance plan and the medical insurance pays the remainder. Simple enough!

Unfortunately if you are sick or injured as a result of an accident caused by the negligence of a third party, the unscrupulous and greedy chiropractor, physical therapist or primary care doctor may try to get paid MORE for the SAME MEDICAL CARE!

Balance billing trickery

This does not sound right, does it? This is what is commonly known as balance billing. Sadly, some medical providers hear the words: “car accident”, “slip and fall”, “bicycle crash” or “truck collision” and they see dollar signs.

Medical providers often attempt to trick

The medical providers often attempt to trick, deceive or fail to provide proper information in an attempt to get paid more, while negatively affecting the best interests of their patients. This is particularly borderline unethical because they are in a fiduciary capacity with their patients who rely on them for their medical care. Why should someone pay more for the EXACT same medical care simply because their accident or injury resulted from the fault of a third party?

Physical therapist for medical treatment

Patients who have auto accident claims pay more for  the same service then non negligence related patients! When an accident victim visits their physical therapist for medical treatment for their injury, fracture or whiplash pain as a result of a motor vehicle crash caused by the negligence of another, it is in that person’s best interest that health insurance pay the bill. Under RI law, the health insurance company has an automatic lien against any compensation that the injured victim receives as a result of the mishap. This lien is NOT premised on the actual BILL for the medical services but for THE AMOUNT ACTUALLY PAID based on the negotiated rates that the health insurance company and the provider have agreed to.

Difference between the actual bill and the amount actually paid

Also according to Rhode Island Supreme court precedent, the injured person may obtain a reduction in the lien for the cost of the RI personal Injury attorney’s representation to secure payment of the lien. This is typically 25 percent off the lien. We all know that the amount paid by the health Insurance is a lot less than the actual bill / cost of that medical treatment. When a physician or physical therapist balance bills, they are attempting to receive the difference between the actual bill and the amount actually paid by health insurance companies such as Blue Cross,  Aetna and United Heath.

The shady Lien game perpetrated by medical providers:

Often, the chiropractor or medical facility will require the patients to sign a lien agreeing that if they receive compensation for their injuries as a result of the motorcycle or motor vehicle wreck their attorney will be legally required to pay the balance of the bill. This is why Rhode Island Car Accident Lawyers call this balance billing. The reason that balance billing liens is borderline unethical is because this practice is premised on trickery,  deception and quasi fraud of the medical providers. They hoodwink and strong arm their own patients to get the accident victims to sign these liens.

Lunch money stolen

They also know that the seriously injured person needs the treatment, has no legal experience or knowledge of the personal injury compensation process in RI and is in no position to negotiate or refuse to sign. Often the injured patient has no idea what they are signing or what is going on. The doctor knows that this lien is often signed before the person has retained a good RI personal Injury attorney.

The medical provider’s staff will make the balance billing lien perfunctory and a condition precedent to receipt of the medical care. It goes something like this: ‘Sign the hippa confidentiality form here, sign this authorization there and sign this document here to make sure we get paid and fill out this form”  The client does not realize they, practically, just got pick pocketed and got their lunch money stolen.

The Med Pay sham

Also, in many cases the medical facility will try to strong arm their patients to put treatment through med pay. They will not inform them to consult with their Providence Injury lawyer. Medical provider’s LOVE med pay because they get paid the full bill not the amount the health Insurance pays. The doctor will not inform them of the implications of paying medical treatment through med pay. The treatment provider will sometimes refuse treatment unless the services are put through available med pay. If a person has good health insurance it is never in the best interest of the injured victim to put his or her treatment through the med pay insurance policy! Med pay also has a lien against the injured person’s injury settlement or judgment.

The med pay provider has not negotiated rates with the treatment provider as is done by the health insurance. Therefore, their lien will be similar to balance billing and will be the full price of the medical services. Also med pay policies pursuant to federal law are not required to give a lawyer’s fee reduction!

Medical balance billing is a practice in the United States where a patient receives a bill for the difference between what a healthcare provider charges for their services and the amount that the patient’s insurance company is willing to pay. This practice can occur with hospitals, doctors, or other healthcare providers. Here’s some key information about medical balance billing:

  1. Causes of Balance Billing: Balance billing typically occurs when a patient receives care from an out-of-network healthcare provider, especially in emergency situations when the patient has little control over the choice of provider. In these cases, the patient’s insurance plan may cover a portion of the charges, leaving the patient responsible for the remaining balance.
  2. Laws and Regulations: In the United States, several states have implemented laws or regulations to protect patients from excessive balance billing. These regulations vary by state and can include restrictions on balance billing amounts, as well as dispute resolution mechanisms.
  3. Surprise Billing: Balance billing is often associated with “surprise billing,” where patients receive unexpected bills for out-of-network care, even when they sought treatment at an in-network facility. Federal legislation, such as the No Surprises Act passed in 2021, aims to address surprise billing and protect patients from such practices.
  4. Impact on Patients: Medical balance billing can be financially burdensome for patients, potentially leading to significant medical debt. Patients should carefully review their insurance policies, understand their rights, and be proactive in addressing any balance billing issues.
  5. Negotiation and Mediation: Patients who receive balance bills can often negotiate with healthcare providers or seek mediation to arrive at a more reasonable payment arrangement. Additionally, patients can appeal to their insurance company if they believe the balance bill is unfair.
  6. Injury and Medical Balance Billing: If you have suffered an injury and received medical treatment, you may be at risk of balance billing, especially if your treatment involves out-of-network providers or services not covered by your insurance. It’s important to communicate with your insurance company, healthcare providers, and, if necessary, legal experts to understand your options and rights in such situations.

Please note that balance billing practices can vary depending on your location and the specific details of your insurance plan. It’s essential to be informed about your insurance coverage and consult with professionals if you encounter medical balance billing issues.

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