An all too common problem that drives Doctors crazy involves a bit of larceny. The insurance plan has approved the medical services, the Physician then renders them the insurance company pays the bill but the Doctor is not paid because the patient has cashed the insurance check and kept the funds.
What can the medical provider do?
The answer is plenty. Suit can be instituted against the patient and his or her spouse if married. In these suits the patient has no defense as the medical services were rendered and the patient kept funds he or she was not entitled to.
In most cases answers are not filed and default judgement is obtained.
If a patient files an answer, I will subpoena a copy of the endorsed check from the Insurance provider and then file a motion for summary judgement. This is a motion in which I, as the Physician's attorney, will state to the Court that there are no facts in dispute- the situation being the Doctor rendered the services, the patient endorsed the insurance check, a copy of which is attached to the motion and kept the funds. I ask the Court for judgement against the patient in the amount of the Physician's bill. Judges very quickly grant judgement under these circumstances.
In one recent case the patient hired an attorney who filed an answer 'claiming he wasn't provided proper medical care." I subpoenaed a copy of the indorsed check from the insurance company and advised the attorney that if the services owed were inadequate, the check should have been returned which it was not. I then filed a motion for summary judgement. Needless to say judgement was entered for the Doctor and the Judge had no sympathy for the patient.
Once judgement is obtained, the endorsement on the back of the subpoenaed check serves another purpose- it tells me where the patient banks and I can then levy and execute on that bank account. Also most patients job information is obtained by the Doctor when the insurance information is taken and salaries can be garnished.
If a patient filed Chapter 7- Bankruptcy which is the format to discharge all debts, a formal complaint may be filed in the Bankruptcy Court objecting to discharge of the debt to the amount of the insurance check. So If a Doctor's bill is $10,000.00 and the insurance check is $6,000.00, a formal complaint will object to discharging the $6,000.00 kept by the patient. In Chapter 13- Bankruptcy which involves not discharge but a re-payment plan, there is no right to oppose bankruptcy.
In conclusion when the patient keeps the check, Doctors do not have to take it lying down or gnash their teeth. There are legal remedies which can force the patient to pay up.