Boise, ID asked in Consumer Law and Health Care Law for Idaho

Q: Is it legal for the physician to require me to pay out of pocket?

I have severe sleep apnea. I was prescribed a CPAP machine by a sleep physician earlier this year. My insurance denied coverage due to low usage the first couple of months, though I am getting good usage now. My physician now says I have no choice but to pay for the machine out of pocket. I asked him about taking it back, and he said they would not. I was advised to ask an attorney: Is it legal for the physician to require me to pay out of pocket? I can get a machine online for about 1/4 the price of this machine.

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1 Lawyer Answer
Patrick E. Mahoney
Patrick E. Mahoney
PREMIUM
Answered
  • Boise, ID
  • Licensed in Idaho

A: Usually, when you obtain medical treatment, devices, or services, you agree to pay the bill, one way or the other. If you have insurance, the doctor submits to insurance for possible coverage. Pre-authorization is determined if necessary. If you do not have insurance coverage, usually you have agreed to pay the bill, which means out of pocket. You could argue that the physician's office failed to get pre-approval. It would depend on all the facts. Consult counsel in your area.

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