[Bera]

I got tangled with a corrupt doctor who billed my American Express card for $6,428.37. The physician told me that it would be covered by my insurance, but when I found out later that she purposely withheld my information from sending it to the insurance so she can bill my credit card (which she had on file to pay a co-pay) because the insurance company would have paid her a much lower rate ($1,950).

I told American Express that even if the insurance company did not cover the claim, I should only be held liable what the insurance company would have paid out the physcian ($1,950) and not $6,428.37. The physician never wanted to speak with me to arrange as they were dealing in corrupt practices. ( I have now filed a report to the medical board)

American Express now says I owe the full amt that was billed by the physician.

My question is, can I sue Amex in smalls claims for the difference? ($4,478.37)?

Thanks and god bless

[ScottGem]

No. Amex paid what was billed by the physician. The physician apparently convinced AMEX that this was a valid charge.

You CAN however sue the physician for not accepting the insurance coverage. As long as that physician was participating in the insurance covergae they were required to accept the insurance reimbursement.

By the way, did you get a response from the insurer indicating what the reimbursement would be?

[Bera]

Hi Scott,

Yes, I wrote to the medical insurance company (via e-mail) and an online rep responded with what the doctor WOULD HAVE gotten paid, had she submitted my records to them. There were 2 separate charges, under 2 separate billing codes totalling $1,950. I know for a fact the reason why this scum of the earth physician didn't send over my documents because she knew she would only get $1,950 (for an hour procedure) and she billed my AMEX (which was on file) for $6,428.37. First, I should have NEVER even been held liable for the charge as this would have been covered. I only learned of the doctors practices from an the ex-medical biller at that office (who was kind enough to call me) and tell me first hand what she did.

The bad thing is that AMEX is a charge card and its due in full.

Even if insurance didn't cover the medical procedure, why can't I pay $1950 (the contracted rate the insurance would have paid the doctor) but I get shafted for $6,428.37.

I have reported the doctor for fraud as well with the state. Thanks for all your help!