What if my insurance won’t pay for a medical procedure?

What if my insurance won’t pay?

Cathy from Perry had a bunionectomy last March. The insurance company paid for it. She continued to have problems with her foot and had to return to the doctor several times. She was referred to a second doctor who performed the same procedure in the same area for a second time. At the time of the surgery, the staff tried to get her to fill out a “police type” accident report form. She refused to do so as it was not an accident related injury. Yet the staff/doctor still filed a claim with her insurance company as if it was an accident.

Within one week of the surgery, she received a letter from her insurance company stating that she needed to fill out the accident report form within 30 days or she would be liable for the $12,000 surgery.

Attorney Virgil advises Cathy to return to the doctor and try to correct the error in filing the insurance claim. He didn’t understand why the doctor would file an accident claim on a case where the procedure had to be redone.

Attorney BJ comments that often in accident or malpractice cases, the insurance company will look to recoup any claims they have paid out. And perhaps this is the case, that her insurance company is seeking to make a claim against the “at fault party” to cover her medical costs.

Attorney Virgil can’t say why her second doctor did such a thing, but perhaps he thought he was helping her in some way and that it will back fire. She needs to get the second doctor to correct the filing with the insurance company.


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