Texas  |  Insurance Law

Legal Question

Asked on: 11/15/13, 11:35 pm

(Texas Resident.) I have two ins. Humana primary and bcbs secondary. I went to an innet par provider for service. Both carriers processed accordingly but primary allowed amount went to deductible. Secondary paid 80% of their own contract. I paid my 20% that my secondary didnt cover. Now. Par Provider telling me that they DO NOT have to adjust off their contractual write-off from BCBS because bcbs is my secondary Insurer. BCBS says they cant force provider to write off even though they are par and accepted assignment because they are secondary. No one will quote me what law supersedes a binding par contract between carrier and provider. Only that the provider doesnt "have to" accept their contract. what law, if any, is on the books that allows the provider to do this? They are balance billing me $1200 + dollars (up to the primary carrier's allowable.) Can you quote me a presidence to fight this?

1 Answer

Answered on: 11/16/13, 8:07 am by Donald McLeaish

Precedent does not exist as it is determined by the contracts between insurers and providers.

Under ACA next yeat this will not occur...good luck

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McLeaish&Associates;, P.C. 402 West Wheatland Duncanville, TX 75116

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