PPO contract with doctor and hospital.

by tom

My son, a minor at the time had a hernia type surgery in Oct. 07. The bill to the doctor and surgery center were paid in full by myself and ins. A year later I get a bill from something called a surgical asst., for $310.00 for assisting with the 40 minute procedure. A surgical assistant is not a doctor, not a recognized profession,and has no license requirements in Colo. I then called the ins. carrier about the matter, and was told that this was not a covered benefit, and that unless I agreed to have an additional charge incurred at or before the procedure that their opinion was that the dr. should pay for his own assistant as the OR staff in a hosp. provides the necessary help for the procedure, and under a PPO contact the dr. is not allowed to bill for more than the agreed upon fee. I wrote a letter to the dr. and the asst. stating this and never heard anymore about the matter and I assumed it was closed. Now over 4 years after the surgery I get a notice from a collection agency that they are taking me to court over this matter. I have no contract orally or written with this asst., would have found another provider if I knew this would occur, but I thought that my bill would be the same at any PPO provider for the same procedure. Now over 4 years later the ins. carrier of course has no record of the procedure ever being done, the nice person in India tells me, as we no longer have them for ins. The collection agency has filed this case not in small claims as I would expect since the bill is now $460, but in county court which is much more formal and will involve an attorney. How would you proceed? One side note $400/hr. for someone who is not even a nurse I wonder what is wrong with medicine. Tom

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Apr 21, 2012
PPO contract with doctor and hospital
by: Debtcollectionanswers.com

I recommend that you consult with a consumer law attorney with experience representing people in debt collection-related cases. Your problem is complicated and the collection agency will be represented by an attorney who has been involved in similar lawsuits countless times so unless you have legal help too, the "decks will be stacked against you." Good luck!

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