Patient sues chiropractor Eavenson over insurance billing
Published: 2009-05-23 23:43:28
Author: Kelly Holleran | St. Clair Record | April 22, 2009
The patient of a chiropractor has filed suit against the doctor and his business, alleging she was forced to pay him extra money after he stopped billing her insurance company.
Melinda Wilborn says she went to Dr. Mark Eavenson at Multi-Care Specialists for treatment after she was involved in an automobile accident on Dec. 23, 2004.
Wilborn went to Eavenson because he was a network provider for her group health carrier, Cigna, according to the complaint filed April 20 in St. Clair County Circuit Court.
"Upon entering his office after the accident, [Wilborn] presented Defendant again with her health insurance information from Cigna and specifically requested that Cigna be billed for care and treatment," the suit states.
Initially, Eavenson was billing Cigna. However, in order to make more money, he stopped sending statements to the insurance company and put a lien on Wilborn's personal injury claim, she says.
An equitable doctrine in Illinois called the "Fund Doctrine" mandates insurance payments made on behalf of an insured as the result of an automobile accident be reduced by one third. Because of the doctrine, Eavenson made more money by refusing to bill the insurance company, according to the complaint.
"That by having her health insurance pay for care and treatment with Defendant, Plaintiff would incur substantial benefit in that Defendant's balance would be zeroed out after payment were made by her health care provider and that the health care provider would be reimbursed on 2/3rds of what it paid minus its pro-rata share of costs at the conclusion of Plaintiff's personal injury claim," the suit states.
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Published: 2009-05-23 23:43:28
Author: Kelly Holleran | St. Clair Record | April 22, 2009
The patient of a chiropractor has filed suit against the doctor and his business, alleging she was forced to pay him extra money after he stopped billing her insurance company.
Melinda Wilborn says she went to Dr. Mark Eavenson at Multi-Care Specialists for treatment after she was involved in an automobile accident on Dec. 23, 2004.
Wilborn went to Eavenson because he was a network provider for her group health carrier, Cigna, according to the complaint filed April 20 in St. Clair County Circuit Court.
"Upon entering his office after the accident, [Wilborn] presented Defendant again with her health insurance information from Cigna and specifically requested that Cigna be billed for care and treatment," the suit states.
Initially, Eavenson was billing Cigna. However, in order to make more money, he stopped sending statements to the insurance company and put a lien on Wilborn's personal injury claim, she says.
An equitable doctrine in Illinois called the "Fund Doctrine" mandates insurance payments made on behalf of an insured as the result of an automobile accident be reduced by one third. Because of the doctrine, Eavenson made more money by refusing to bill the insurance company, according to the complaint.
"That by having her health insurance pay for care and treatment with Defendant, Plaintiff would incur substantial benefit in that Defendant's balance would be zeroed out after payment were made by her health care provider and that the health care provider would be reimbursed on 2/3rds of what it paid minus its pro-rata share of costs at the conclusion of Plaintiff's personal injury claim," the suit states.
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