Is this legal? (Medical)

Recently my wife got pregnant. The doctor wanted an ultrasound so she had us go to a different doctor to have it done. All was fine and dandy but after the ultrasound we switched doctors. Now the doctor that did the ultra sound is sending us the bill for the ultrasound saying that they can’t get paid because we switched doctors.

What can be done about this? Are they in their legal right to send us the bill?
Thanks in advance!

IANAL, etc. If they performed a service, they can send you a bill. You can then send it to your insurance company, if you have one.

Yes, I have insurance. That is why I don’t agree with them sending the bill to me. I pay for this to be taken care of already :\

So send the bill to your insurer. The doctor most likely sent it to you because he doesn’t have your insurance information.

If the doctor is contracted with the insurance company, give the doctor your insurance info and let him file it (unless there’s a filing time restriction). That way you’ll pay your co-pay/co-insurance/deductible.

If you submit the bill to the insurance company, they may only pay you a discounted amount and the doctor may bill for the entire amount.

I am not a lawyer or a doctor, and I’m slightly confused by your story, but my sister is an OB, and I believe a pregnancy is usually billed in full, from beginning to end. So that may be your problem. Or I may have totally misread your question.

Doctor’s offices are not obligated to submit their bills to your insurance, unless prearranged.
You are responsible for service rendered. You may pay it or forward it to your health insurance. If you forward it and your insurance is slow paying you may be responsible for late fees.

You did.

Radiology and lab services are usually billed separately if they’re performed by entities outside the OB’s practice.

Call the ultrasound billing office (the number should be on the bill) and find out exactly what their problem is. If they participate with your insurance, they have to submit the claim; that’s usually a term of their contract. If they don’t, you can submit it and pay a higher portion. But this business about “changing doctors” is horsehockey.


Here is the thing. If I had remained with the previous (horrible) doctor this would not be happening. Everything would have been taken care of through my insurance. The ultrasound office is saying that because I switched doctors that they are not affiliated with the medical group that my new doctor is with.

My insurance never changed. Everything is the same. I switched doctors and this new doctor is in a new medical group. They say because of this they are going to bill me.

I suppose I will still try to submit this to my insurance but it still boggles me that I am being forced to pay this bill when I never had to pay anything on the first pregnancy. My insurance took care of every little detail.

Any relationship between the ultrasound office and any medical group is between them. As long as your insurance hasn’t changed, it shouldn’t matter.

The only thing I can think of is this may be a referral issue. If you had to get an insurance referral for the ultrasound, the ultrasound people may have a problem with filing a claim using what they think is an “old” referral. But even that shouldn’t matter, since the previous OB ordered the study, not the new OB. Unless they did, and a new referral would be required.

That said, I can’t think why this ultrasound wouldn’t be a covered expense. I’d call the insurance company and talk to them. Tell them what you posted here, then find out what they have to say.


What MsRobyn said.

This is certainly misleading.

If you go to your doctor’s office and ask “Do you accept Blue Cross/Aetna/Travelers” and they say “yes” then you should fully expect them to send the claim to your insurance company and wait the requisite contracted period for their payment.

I’ve seen some doctor’s offices try to pull the bullshit wehre they tell you they are not responsible for submitting the claim to your insurance company…my talks with them usually go like this:

joe: Yeah, um, you see this part where it says you’re not obligated to try to get the payment frmo my insurance company?

office manager: yeah

joe: if you tell me you take my insurance, I damn well expect you to ask them for money before you ask me. otherwise, tell me you don’t take my insurance.

om: well, we’ll make an exception for you this time (I crossed it out on the forms they give you to sign) …

any doc that tries to give you a “late fee” for not paying your bill when they told you they accepted your insurance usually responds well to the response of “if you don’t try to collect from the ins company first, you’ll have a hell of a time collecting from me…”