OHIO REQUIRES MEDICAL PROFESSIONALS TO SEEK COMPENSATION SOLELY FROM THE HEALTH INSURANCE COMPANY AND NOT FROM THE PATIENT

Throughout our personal injury practice, we commonly see medical professionals that are reluctant to submit their medical bill to our clients health insurance company and aggressively pursue a client and file lawsuits against clients to force them to pay their outstanding bill.  Section 1751 of the Ohio Revised Code and the Ohio case of Hayberg v. Physicians Emergency Service and Robins Memorial Hospital make it very clear that a hospital or a physicians office is obligated to bill a client’s health insurance company and not our clients directly.

Revised Code Section 1751.60 provides that “every provider or health care facility that contracts with a health insuring corporation to provide healthcare services … shall seek compensation for covered services solely from the health insuring corporation and not, under any circumstances, from the enrollees or subscribers except for co-payments and deductibles.”

Enrollee is defined pursuant to Revised Code Section 1751.01(K) as “any person who is entitled to receive healthcare benefits by a health care insuring corporation.” Healthcare facility is defined pursuant to Revised Code Section 1751(M) as “any facility that provides preventive, diagnostic, therapeutic, rehabilitation, mental health, intermediate care or skilled nursing services.” A health insurance company is defined as “a health insuring corporation” pursuant to Revised Code Section 1751.01(P).

If your medical provider refuses to properly bill your health insurance company, you must immediately send them a letter that references Section 1751 from the Ohio Revised Code and the Hayberg court decision and demand that their facility is obligated to bill our client’s health insurance company and not the client directly.

The rationale behind utilizing the health insurance coverage for these types of automobile and personal injury cases is that it allows the medical facilities to be paid promptly pursuant to the contract they already have with the health insurance carriers. The medical facilities do not have to wait for the termination of the case to be paid. They can get paid as they would typically. Our clients are also able to receive treatment and should only be responsible for any
normal out-of-pocket expenses he/she may have such as co-pays.

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