Can I sue a medical practitioner for not filing my insurance claim?
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Can I sue a medical practitioner for not filing my insurance claim?
A month before my son was due, our mid-wife closed her then business. We saw her 6 times for prenatal care up until that point and were required to pay the charge in full so many days before his due date. So we had already paid for in full for his care, the birth and several post-birth visits. We were told the claim would be filed after the birth. Since we had to transfer to another doctor at a hospital, we had to pay the global charge with that doctor as well, who filed our claim with our insurance company for
her services once my son was born. We have stayed in contact with the original midwife but it has been almost 6 months since she closed and our claim has still not been filed correctly. There have been a plethora of excuses for this – biling employees leaving, not having the correct name/ID number for our insurance even though a copy of our insurance card was made, not using the correct code for prenatal visits while filing. We have been very patient with her, as she is operating on her own now. However, she is still practicing at another location and has has been filing our claims
incorrectly, thus we have not received our refund using
Asked on May 12, 2018 under Business Law, Texas
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 5 years ago | Contributor
Yes, you could most likely sue her for failing to file the claim correctly There are several different legal theories you can and probably should cite in the suit (you can bring a single claim under multiple theories of liability; this enhances the odds that the court will find at least one basis for liability persuastive). For example, this could be professional negligence, since it appears to not meet currently accepted standards of conduct for medical professionals; it could be fraud, if she had represented to you before you hired her services that she would submit the claim and you'd get money back, and that was part of your decision to hire her; it could be breach of contract, if there was an agreement, oral or written, between the two of you that she would do this. Since litigation has its costs (time and money), if you file and then she offeres to settle, even if you don't get everything back, if you come out ahead of where you are, you may wish to take the settlement rather than go all the way through trial on the case.
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