Q: I have a question about health insurance and the provider
My son saw a therapist who confirmed they are in network with our insurance, Anthem. Yesterday we received an email from the provider saying they have not received any payments from Anthem for the last 6 months (for every patient thru Anthem), and they received a letter from Anthem terminating their contract as of September 9th. The provider tells us Anthem owes them over $800 for my sons appts and over $200k for all their patients. I am worried the provider will send us a bill for the $800. We weren't expecting that since we were told they are in network. Anthem's website also shows them as in network. We cant afford to pay this amount and i'm very stressed that they will try to send it to us if they cant get it from Anthem. It seems to me like this should be between Anthem and the provider? Can the provider send us this bill and are we responsible for it??
A: I would advise you to firstly confirm with Anthem directly regarding the status of your provider's network status and the payments in question. Secondly, under California law, healthcare providers generally are not allowed to bill patients directly for services that are covered by their insurance — this is referred to as "balance billing." However, it's important to review your insurance policy and possibly consult with an attorney who focuses on health care law to understand fully your potential liability in this situation.
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.
