Bridgeport, CT asked in Contracts, Collections and Health Care Law for New York

Q: Can my mom's doctor's office ask for co-payments (going back 6 months) when she was told she was covered? New York

My mom started with a new physical therapy practice back in Aug 0f 2019. She has medicare and blue cross blue shield. They said they accepted her insurance and proceeded to make copies of her insurance cards. At each visit, they never asked her for a co-payment. She recently called the office to schedule a new appointment (after taking a break due to the virus) and she was advised that she has a $682. bill for co-payments. After speaking with a manager, it turns out that the person that accepts her insurance works at another office however they would make arrangements for this therapist to take my mom's appointments going forward. They told her she would still have to pay the $682 from co-payments that she was never told were accruing. Also, the manager agreed that it was the office who was at fault for not collecting co-pays at each visit and for not informing her that she was not covered fully. They are still seeking payment. What legal recourse does my mom have?

3 Lawyer Answers
Michael David Siegel
Michael David Siegel
Answered
  • New York, NY
  • Licensed in New York

A: None. Payment is either required by her policy or not. If required, the failure to collect it is not a waiver of the charges.

Tim Akpinar
Tim Akpinar
Answered
  • Little Neck, NY
  • Licensed in New York

A: Unfortunately, all medical offices will collect all co-payments where due. But most do not like to present patients with surprise bills. She could ask them if they would consider installment payments or some sort of deferment plan to reduce the financial shock. It looks like your mom in good faith and by no fault of her own did not know these charges were accruing. They may or may not show leniency, but it could be worth asking. Good luck

Tim Akpinar

George E. Patsis
George E. Patsis
PREMIUM
Answered
  • Estate Planning Lawyer
  • Lindenhurst, NY
  • Licensed in New York

A: Your mother should review the explanation of benefits statements that are issued by Blue Cross Blue Shield. The EOBs will indicate what amount is due per the insurance policy. It is unusual that the co-pays were not collected at the time of service but it is perfectly acceptable to bill for them.

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