Glen Burnie, MD asked in Contracts, Civil Litigation, Collections and Health Care Law for Maryland

Q: I'm being sued by a doctor who did my surgery 3 years ago.

Three years ago I had my gallbladder removed. At the time I had only recently been approved for Medicaid, but didn't have an insurance card or anything like that. A couple of weeks later I got my insurance card in the mail. So, I brought it into the hospital and explained to them how I had not had the insurance information at the time of my surgery. They took my card and entered the information. Now, I'm being sued by the doctor for payment and the time limit for claims is expired. Is there anything I can do to fight it?

1 Lawyer Answer
Mark Oakley
Mark Oakley
  • Estate Planning Lawyer
  • Rockville, MD
  • Licensed in Maryland

A: You have two issues: (1) whether you were covered by Medicaid at the time of the surgery, and if so, whether you provided your Medicaid information and met the conditions of coverage--and the doctor submitted their request for payment--within the time frames required; and (2) whether the doctor filed suit in court within 3 years of the date of service. It is not possible to evaluate which, if any, defenses you may have based on the facts provided in your question. For issue #1, you need to provide details as to dates and coverage requirements for Medicaid to be responsible. Was pre-approval for surgery required? Did you need a referral first by your primary care doctor? Whether the doctor must accept Medicaid's coverage requirements and limitations is another unknown. Did the doctor fail to submit his bill to Medicaid in time to be considered for payment? Did he accept Medicaid coverage to begin with? For issue #2, you need to provide: date of medical service and date suit was filed, which will determine whether of not you have a statute of limitations defense. If you do not have a viable defense, then you can negotiate settlement on payment terms to avoid a judgment against you, or if the amount and other financial circumstances justify it, consider your bankruptcy options.

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