Who is responsible for charges if a doctor uses a labthat is not accepted by a patient’s insurer?
Get Legal Help Today
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
Who is responsible for charges if a doctor uses a labthat is not accepted by a patient’s insurer?
Last month my girlfriend went to her oncologist and they performed a BM aspiration and sent out the sample out to be analyzed. Instead of sending the sample to the usual laboratory, they sent it to a lab in different lab. Today we found out that there had been a $17,000 charge into my girlfriend’s insurance from the lab tests and they weren’t going to pay any of it stating “out of state physician”. Who is responsible for this charge? We had no idea the doctor would do this.
Asked on May 22, 2011 under Insurance Law, Florida
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 13 years ago | Contributor
First, your girlfriend is "responsible" in the sense that she has to pay. Her sample, her test; the lab may look to her for payment, and take action (e.g. sue; report her to credit rating agencies) if she does not pay.
However, that said, if the doctor's office sent the sample to the wrong lab after having said that it would go to a different lab--or arguably, even without saying it explicitly, but after having created a reasonable expectation, based on past practice, as to where the sample would do and what it woudl cost--then your girlfriend may have a claim against the doctor's office for reimbursement. The main thing will be to show that they said it would go to lab A, not B; or that since it went to A every other time, your girlfiend was entitled to think it would go to lab A again--and that the office did not tell or warn her it was going to B.
IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.