legal question

[Guest guest]

Hi All,

I received an unusual letter from an attorney (nameless) representing a worker's comp claim on one of my patients. The claim is over a year old. payment was denied based on the insurer's claim of 'uncovered services'. the patient hired an attorney. What happened was: This patient was a referral from a local MD. After treating for 2 months with referrals from the MD, and the insurance paying, all of a sudden, the ins carrier stopped paying. My billing staff called and wrote letters for over 30 days while we continued to treat as per the MD instructions. Finally a nurse for the ins carrier called us back and said this patient had a special managed care type of insurance and we weren't providers. So all our services would be 'uncovered'. When my staff asked why they didn't inform us, the nurse said "we are only required to inform the MD PCP not you. Oregon law does not require us to inform ancillary treating doctors."

The letter from the patient's attorney reads:

This law firm represents the above patient in a worker's comp claim. We have been asked to contact you regarding billings for medical services provided to our client.

Oregon law does not allow collection of medical services billings frrom a disabled worker if there is a pending claim for compensation that relates to the unpaid billings. Medical providers are instructed first to bill the employers compensation carrier and then, if denied, the worker's health insurer. If there is no health insurer, the billing may be submitted to the worker, but no other effort shall be made to collect on the account until litigation continues. ORS 656.313(3)

Medical providers who take improper action to collect billings risk civil liability. If you, or your assocates, have any questions regarding disputed medical service billings to injured or diseased workers, please contact any atorney of your choice for an explanation of the restrictions on billing and collection.

Do not consider this a "letter of protection." We make no promises regarding payment of your billings. even if we made such a promise, this will serve to inform that we must give the money to our client, regardless of promises to any medical provider, if our client so insists upon "settlement" of her claim.

Here are the facts so far:

The patient has received treatment and been released. The bills have been denied by her work comp ins carrier on 5-7-02. Tomorrow, my secretary will find out if this patient has health insurance we can bill. For a short time we sent statements directly to the patient. Once she hired an attorney, We began sending regular statements to the attorney -since (7-02.) The letter listed above is the first contact the attorney has made with our office.

My questions:

1. Is the attny trying to tell us that we probably won't get paid?

2. We never called, harassed or even mentioned collections. Is this attny letting us know that we have NO recourse?

3. Is he trying to tell us that the patient probably won't get a settlement that can cover our billings?

Whaddaya think?

Minga Guerrero DC

Portland, OR