“My Doctor Is Suing Me in Ohio”

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Throughout the years at our personal injury practice, we’ve seen a reluctance from some medical professionals when it comes to submitting their medical bills to our clients’ health insurance companies. We’ve even seen some medical professionals aggressively pursue clients and file lawsuits against them to try and force them to pay their outstanding bills.

Is this happening to you in the State of Ohio? Keep reading for more information on this subject.

What Does Ohio Law Say?

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 physician’s office is obligated to bill the health insurance company – and not the patient.

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).

What Are My Options?

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. Demand that their facility is obligated to bill the health insurance company and not you 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 typically would.

Questions? We’re Here to Help

If you have any questions about this topic or any other personal injury matters, please feel free to contact our law office in Columbus, Ohio.

Ask Tom a Legal Question »

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