This is a throwaway because I don’t want my personal situation linked to my main. It’s a bit long, so thanks in advance for your time.
I am extremely confused and would appreciate help with my complicated situation. I am a PhD student and a bill of thousands of dollars is financially difficult.
Late last year, I was a passenger in a car-sharing service (think Uber/Lyft) that got rear-ended and I got whiplash. The car-sharing company offered coverage for personal injury treatment resulting from the accident. The insurance is through a large insurance company (LIC).
I started physical therapy for my neck. This continued through spring 2023 and thankfully my neck got mostly better. I didn’t realize this at the time and should have read more closely, but the form I signed said that I needed to pay if the insurance didn’t. I have since been informed that this is common (I am in Texas).
There is a third party health care company (TPHC) that handled financing. I am still not sure why they were involved, but I suspect they are a middleman the provider hires to try to get insurance companies to pay the full amount for treatment. Initially, I thought it was a different branch of the provider’s finance department. After treatment began, I received a lien in the mail for the treatment, which was unexpected. I inquired and was informed by TPHC that this would protect me if the insurance didn’t pay, even though my name was on the lien.
Every few sessions, we had to get an authorization from the insurance to continue treatment. There was always a hang up of some sort. LIC said they hadn’t received any bill, I connected them with the provider/TPHC, and approval came for treatment to continue because TPHC said they would send the bill at the end. I am now told that TPHC was paying the full amount for my treatment to the provider and would charge LIC at the end.
Three months after treatment ended, I got a courtesy email from TPHC that LIC paid the provider *a portion of the cost* directly and is refusing to pay the rest to TPHC (that portion of the cost has been reimbursed to TPHC). I called LIC, and they told me that they have a negotiated price with the provider (which is a chain of PT places) and the rep said LIC has “fulfilled its commitment” and “closed the case”. TPHC said they have been in contact with them for months, but they are refusing to pay.
What do I do? This situation is complicated due to all the third parties and the car accident and I shouldn’t need to pay anything out of pocket as I did not exceed the coverage limit. Are there any strategies I should use when I call LIC next? And how does the lien affect this all? I appreciate any advice.
I see two options.
Get some proof of the negotiated rate between LIC and the provider and hope that this means the provider will reimburse TPHC for the difference.
Complain at LIC until they agree to pay, going up the supervisor ladder if needed.
TPHC reps have been in regular contact with me for a few weeks now and are continuing to reach out to LIC. But they have been clear that if it doesn’t go anywhere, they will come after me for the remaining balance.