If a medical provider has an agreement on rates with an insurer but hen asks for more when a patient files a claim, is the patient responsible for the rest?

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If a medical provider has an agreement on rates with an insurer but hen asks for more when a patient files a claim, is the patient responsible for the rest?

I have a doctor who charged my insurance co more than their agreement. This fact is printed on the back of my copy of the claim from my insurance co. Why would the practitioner come after me for the difference? I would like to know if I can do anything about it.

Asked on April 12, 2012 under Bankruptcy Law, North Carolina

Answers:

FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

You need to carefully read your medical insurance policy with respect to what particular charges you will be assessed for various treatment such as a co-pay when you first see your treating physician on each visit.

If your treating physician has agreed to accept so much for a certain visit with your insurance carrier then he or she is expected to honor that agreement where you are a third party beneficiary under the insurance policy. If your physician is seeking the difference in what the agreed upon rate is with your insurance carrier, I suggest you first consult with a representative with your medical insurance carrier and then your treating physician to get the answers you want.


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