Mercury slammed for not paying $4300 Med Pay - $660,000
Plaintiff clients requested Med Pay reimbursement from Mercury for some $4,300 in bills, incurred while treating for a moving auto accident.
Mercury delayed reimbursement, demanding signed authorizations and a ‘sit down interview’ with each of the doctors.
Plaintiff complied. Mercury sent the Med Pay request to their SIU [Special Investigations Unit—fraud], which, by law, each insurance company must have.
SIU generally is a Keystone Cops operation. They believe anyone asking for money must be dishonest. In this case, they began to try to find ‘dirt’ against the doctors to justify denying payment. One SIU agent went unannounced to a doctor’s office demanding a ‘tour’. It’s an old scare tactic, and under federal law, agents certainly cannot jeopardize patient confidentiality by wandering in a health clinic without specific authorization.
This SIU agent demanded first to see the equipment, computers and files, and then to take pictures of employees and the facility. The doctor refused to comply with the bizarre requests. Mercury used this to deny payment for ‘lack of cooperation’.
SIU reported their concerns to the National Insurance Crime Bureau, and the California Dept. of Insurance. Both rejected the SIU.
Soon the 3rd Party claim was settled. In September, 2011, the plaintiff still demanded Mercury issue the Med Pay. Mercury refused.
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Continued next column >>>>>>>
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Wednesday, July 30 @ 1:00 PM Sharp!
New case for Getting Your Med Pay
With our guest
Arun Dayalan, Former Defense Attorney
E-mail johntawlian@shawnsteel.com
for telephone # and pass code
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CONTINUED……
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Suit was filed against Mercury for fraud, breach of contract, and bad faith in June, 2013. Last month, the jury awarded the plaintiffs $5,000 for Med Pay, over $20,000 for attorney fees and over $635,000 for emotional distress. The jury was unhappy that Mercury wasted everyone’s time over a $5,000 claim.
We will provide the citation when the case is published
| 1. | Noted former defense attorney Arun Dayalan will speak at our teleconference in July—how this case can change your Practice. |
| 2. | Use this case to remind all future Med Pay carriers of the risk they face with a bad faith actions. |
| 3. | Always keep all your demands for Med Pay in writing…build a written record. |
| 4. | After their first rejection or delay, always have your patient co-sign the Med Pay bill demand letters. [visit shawnsteel.com for med pay collection kit] |
| 5. | After the first rejection or unwarranted delay, file a Complaint to the CA Dept. of Insurance, which the patient must sign. |
| 6. | We will make a special announcement at the July teleconference about enforcing your Med Pay. |
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