I’m a doctor in Oklahoma. State Farm informed my office today that they will only pay (roughly) 33% of our medical (chiropractic) bill. They say the new rates are due to the fact that they are now contracted with Coventry, as we are, so they are only responsible to pay us ‘our’ contracted rate (i.e. we are indirectly contracted with State Farm via Conventry Health Care).
Is this Legal? How do I recoup the remainder of my bill? Can I? Do I have to bill the patient for it? Regards.
Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.
There are several issues involved. The insurance company with whom you had a prior agreement to pay a certain percentage of your submitted chiropractic bills should be liable to pay those bills. Of course this assumes you submitted the bills to the previous insurance company in a timely manner. If they refuse to honor the contractual agreement they had with you, you may have a right to sue them for breach of contract.
The next issue involves the new insurance company – Coventry Health Care. It is altogether possible when they took over the insurance from your previous insurance company, their doing so included an assumption of the contractual agreements for claims submitted before the transfer.
To really know about the contractual agreements you will have to retain an attorney to file suit. Once she does she’ll be able to subpoena the transfer documents from one insurance company to the next to see if Coventry agreed to assume the contractual obligations of your previous insurance company.
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.
Best of luck,
How Much is Your Injury Claim Worth?
Find out now with a FREE case review from an attorney…
Search for a Previously Answered Question