They generally can. I'm not certain of the specific rules for Medicare billing, but in just about all forms of insurance for health care claims, examiners can delay claims for CPT coding errors and allow a medical office to resubmit claims with the proper codes. It also depends on the... View More

T. Augustus Claus Lawyers, want to be a Justia Connect Pro too? Learn more ›
answered on Sep 28, 2023

In New York, a doctor generally can recode and resubmit a claim to insurance if the original claim was denied. However, the recoding must accurately reflect the services provided, and the practice could be subject to audit. Additionally, Medicare has specific rules and timelines for resubmitting... View More

Sorry to hear what you've been going through. It is unlikely that your insurance company would be responsible for any physical harm you sustained due to its denial (or delay) in approving additional physical therapy visits. Although you could conceivably claim that the insurance... View More

You raise a very good question - and one that does not go overlooked by attorneys in challenging denials of medical care. Unfortunately, it is also a difficult issue to argue in most settings where a claim is closely processed with valid independent medical exams or peer reviews. If you have an... View More

You could make the argument that they are responsible for the incorrect information. They could respond with an argument that the long version policy applies, or that their post is subject to changes, or other provisions. If the denial is substantial, there are health care attorneys who litigate... View More

I'm very sorry for the loss of your dad. One option is to try to arrange a brief consult with an attorney - it would be helpful to know the basis of the carrier's denial of a refund. It could be a matter of weighing the costs of litigating the potential refund against chances for a... View More

Attorneys who handle medical billing disputes apply various fee arrangements, depending on the type of insurance (no-fault, private, etc.), volume of claims (in terms of whether it's a high-volume institutional client, such as a large medical office or single-transaction individuals),... View More

This isn't an Insurance Bad Faith matter (the category where it is posted). You could repost and add "Elder Law" and "Health Care Law" as categories for better chances of a response - attorneys there could have the best insight into this. Good luck

It's difficult to comment whether there was an insurance law or policy violation without knowing the types of insurance, policy conditions, sequence in which hospital billed or otherwise coordinated the claims process between the two carriers. There are health care attorneys who handle billing... View More

I'm sorry for your ordeal. You ask if you could sue. I think it would be difficult to find a law firm to handle such a matter on a contingency basis. MRIs are often initially denied as a knee-jerk reaction in many instances. They are big-ticket items compared to other less-sophisticated... View More

I'm sorry you find yourself at the end of a collection action with the medications. It's difficult to comment definitively on your position without seeing the terms of the policy and other paperwork. However, it sounds like they may be relying on the position that the patient has a... View More

Some elements of the scenario are not fully clear, but from the brief facts, it does not look like a case of insurance fraud. Insurance fraud cases generally involve deliberate conduct with the intent to deceive the other party. This looks more like it could be an administrative or communications... View More

It could be difficult to speculate why a dental or medical office would apply different billing protocols. As a convenience to the patient, some offices do not bill patients but instead, have them complete paperwork enabling their billing staff or contractor to bill on patient's behalf. When... View More

I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law... View More

When you state you're the "third party" I'm assuming you mean you're the claimant and not a third-party defendant. Regardless, as my colleague correctly advised, the claims adjuster's change in position can be due to many reasons. More likely than not, the adjuster... View More

Your homeowner insurance company will thoroughly investigate the matter. It is not enough for someone to simply fall. They must show that it resulted from a defect in the surface or negligence on your part. The claims adjustor or defense attorney from your insurance company should be able to... View More

One option might be to contact the insurance carrier to request duplicate cards. Good luck

Tim Akpinar

I'd recommend looking into New York's State's Unclaimed Funds registry, which can be found by clicking on this link:

https://www.osc.state.ny.us/unclaimed-funds

If you're entitled to funds that are unclaimed, they might be held by the State in escrow.

Good luck with your case!

I'm sorry for your ordeal that makes a difficult situation even more painful. It appears you've already requested records. It's difficult to offer step-by-step instructions here, as the next step could possibly require litigating the claim, depending on the situation. Reach out to... View More

There is a resource on the case here on the Justia site. Enter the following page link in your browser:

https://law.justia.com/cases/north-carolina/court-of-appeals/1987/8715sc224-1.html

Good luck

Tim Akpinar