Legal Question in Insurance Law in Georgia

Does a doctor have an obligation to file for a patients medicare coverage? It appears that three items (of a long list) were not filed, and no bills were sent to my father. Four years later, a new bookeeper sent it to collections. The charge that shouldn't exist has now trippled. What obligation is placed on the doctor by Medicare to file these claims?


Asked on 4/25/12, 6:22 am

2 Answers from Attorneys

Glen Ashman Ashman Law Office also dba Glen Ashman Attorney

Doctors can file insurance claims as a convenience but every patient has the duty to file the claim and your father should have followed up when he didn't see bills. So he was negligent.

However, do not assume the bill is collectable now. Set up a meeting with the doctor (not thE bookkeeper) and insist the bill be taken from collections and submitted to Medicare. If the doctor is unhelpful, fire him, but you likely owe the bill. Do talk to Medicare before paying anything. Instruct the collector in writing that they may not call you or write you, and that you will only deal with the doctor.

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Answered on 4/25/12, 7:20 am
Ronald Arthur Lowry Ronald Arthur Lowry

In addition to what Mr. Ashman said, the fact that no bills were ever sent to your father may insulate him from the interest and fees. This is a collection matter. Under Georgia law certain things (notices, etc.) must be done in order to collect (1) the debt; and (2) interest and fees. If they didn't bill him way back when they probably can't get interest and late fees going that far back. Also, a doctor who agrees to accept Medicare also agrees to not charge Medicare patients an amount above what Medicare would pay. If this doc and his bookeeper are trying to charge more than that (usually substantially less than half of normal medical billing) you should object to paying the higher amount, too. That would be a back-up position. My first position if this were my father would be "Hell No!"

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Answered on 4/25/12, 11:29 am


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