What can I do if I went to an in-network chiropractor but when my insurance limit for the number of visits to be paid for was met, I was billed for all services above the limit?

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What can I do if I went to an in-network chiropractor but when my insurance limit for the number of visits to be paid for was met, I was billed for all services above the limit?

I had an HSA that never notified me I had a 12 visit limit per year. After my limit was reached, the chiropractor’s office continued to file claims, which of course rejected. I never received a bill from them. When I stopped going, they said I owed them a lot of money. I was told that I was liable for the full charge rejected by insurance – it was not adjusted. I told them that I would never have continued if I knew I was liable for $300-$350 per visit. They said that I should have known what my responsibility was because of the EOB. But EOB’s say in large print “THIS IS NOT A BILL”. I also noticed they were billing for services I never received. Is this insurance fraud?

Asked on June 1, 2015 under Business Law, Ohio

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

The insured is responsible for knowing his or her  policy limits and terms, and for tracking how many visits they have, what they are responsible for paying, etc., so this would not be considered insurance fraud. Also, in this country, even if there is a problem with your insurance--even if your insurer did something negligent (careless) or even intentionally wrongful, so that you could sue the insurer and recover money--you are still responsible for all medical bills for services rendered to you, so you in any event need to pay your chiropractor. You may, however, be able to negotiate some reduction in price and/or payment plan, and if paying the full amount at once would be burden, it's certain worth trying.


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