Shoulder Surgery Tangled Web

by Luis
(Elmwood Park NJ)

I had shoulder surgery in 2008 and during the process of pre-op my job changed insurance carriers. The doctor was provided with both insurance cards at the time and alerted of the insurance change. The doctor's administrative office claims they filed the claim with the insurance carrier in 08 but received denial in 2010. I never received bills, notice or any type of communication from doctor alerting me that there was a problem until November 2011 when I was served with a lawsuit. Also the doctor claims I never provided second insurance carrier information which is false and on their own medical billing form it shows them providing a claim in 08 to the second insurance carrier and being denied by first insurance carrier in 2010. Doesn't make sense to me at all. I think they filed a claim with the old insurance carrier in 08 (I have proof) they denied it and the doctor followed up and never re-filed the claim with the second insurance carrrier at all. Am I responsible for this bill? I don’t think I should have to pay this bill because of their administrative error. What can I do? Do I respond to the Notice of Motion Summary judgement by sending the court all the documents I have to prove my case. Please help- Luis

Comments for Shoulder Surgery Tangled Web

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Feb 24, 2012
Shoulder Surgery Tangled Web


Ultimately you are responsible for the medical debts you incurred as a result of your shoulder problems. However, it sounds like you should not be held responsible for all of it given that you had insurance at the time.

I recommend that you consult with a consumer law attorney in your area right away who helps people resolve debt collection problems, especially since you have been sued over the money you owe and the other side will certainly be represented by an attorney.

Also, it is essential that you respond to any and all legal notices you receive related to the lawsuit and that you show up in court on the day of the hearing for the lawsuit. If you do not, the plaintiff in the lawsuit will probably be awarded a default judgment against you. In other words, the plaintiff will win the case and you will be ordered by the court to pay the full amount of the judgment without your ever having had an opportunity to present your side of the conflict and possibly achieve a very different outcome.

Good luck!

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