Complaint Review: 1st Choice Healthcare - Dr. Hamid Sadri

http://www.sos.state.ga.us/plb/chiro/

There are downloadable forms that you can send, as well as attaching any supporting documentation. Also attach a copy of your Rip-Off report..the statement from the insurance person stating that this provider is under scrutiny may be helpful to you.

I agree with the previous poster who stated that what happened to you was a scam cooked up by your Personal Injury attorney..never, ever go to a physician or chiropractor that they want you to go to. I used to live in Dekalb County..same old scam with new faces.

Good luck with this and keep us updated.

If you were in an auto accident why didn't the attorney pay him out of the settlement money? Fighting with this Chiropractor isn't going to help because he most likely has deeper pockets than you. If he has a judgement against you consider file chapter 7 bankruptcy and any judgement he has agaisnt you will be worthless.

Also if he really did all these things to you, make a large picket sign and walk up and down in front of his office (make sure your on public poperty). When his patients see he has and upset, angery, and hurt patient they will seek treatment somewhere else.

Lastly if his treatment did not work as he promise or if it made you worse you can sue him for malpractice. just him having to make a insurance claim on his insurance will cost him a ton.

ATTENTION READERS: All information printed in regards to the complaint against 1st Choice Healthcare, submitted by myself, are STRICTLY my opinion and are not based on the outcome of any investigation. Two investigations are still pending.

Hi, I'm Erica, the person who wrote the original report. I'd like to clarify a few things.



1. When I entered your office in 12/2002, if you were not a participating provider, then why did you say you were? Did you lie to me? I specifically asked this question because I have HMO insurance. It is my responsibility to MAKE SURE that any healthcare provider whose services I seek IS a participating provider or my claims won't get paid. In all of my years, I always check first to make sure I am utilizing a participating providing and you said that you were. Your office accepted my insurance card, made copies, then told me that my claims would be filed at the end of my treatment. I had every reason to believe that you were a participating provider. In fact, my insurance carrier told me that you were a participating provider in 2002. I am in the process of filing a grievance with them (as suggested by THEIR fraud investigator) for giving me incorrect information if indeed it was incorrect.



2. Yes, your offices policies were explained to me, but I was never told that I would be under the care of the other doctor. I specifically asked for you when I came to your office and my very first appointment was with you. Why would you put me under the care of another doctor without my consent?



3. Your statement that "there were no benefits available and therefore the patient had to be held responsible for the entire balance" is not true. Chiropractic benefits have always and still are available to me, I just have to use a participating provider. That's why I made my appointment with YOU. I was told that you were a participating provider!



4. You are correct in stating that I refused to pay the bills that you kept sending me. First of all, my insurance carrier told me NOT to pay you anything because you were under investigation. If you were a participating provider then you needed to be paid by them, not me. Second, my insurance carrier told me that the bills WOULD be paid if you filed them under your name (you were on the phone when they said it). They refused to put it in writing therefore you refused to refile the claims in your name. Since the claims were filed under a non-participating providers name, of course they were denied!



5. I did not file the original complaint with my insurance carrier, it was filed on my behalf by the customer service rep that I had explained my situation to. It was then that you called me asking me to "call off the dogs". Do you remember saying that? You even told me that you would be willing to dismiss all of my bills and reduce my balance to $0. You said that this happens all the time and sometimes doctors have to take a loss. Well, I held up my end of the agreement and called my insurance carrier to ask them to stop the investigation, but I was told that I couldn't because I was not the one who requested that the investigation be started in the first place. It was out of my hands, but at least I did call them like I said I would. You, on the other hand, did not stick to your end of the agreement and you started billing me a few months later. I refused to pay anything, even the co-pays, until you filed the claims under your name, which you never did. Why wouldn't you just file the claims under your name? Were you afraid they would get paid?



6. Your statement "She continued to push the issue with her insurance and insisted that they further investigate this matter." is incorrect. I wasn't pushing the issue with my insurance carrier, I was pushing it with you! I NEVER insisted that they further investigate the matter, in fact, I wasn't the one who initially asked them to investigate the matter (as I stated above). You were the one who sent the information directly to the third party company and they denied them. When I called them to find out why they denied them, I was told that NO claims were EVER filed with them through my insurance carrier. You sent them the information, it was reviewed, and a letter was written. But I was told by this third party company that the letter never should have been written because the claim was NEVER filed with them through my insurance carrier.



7. You sued me in civil court and the only reason you won was because I signed a document stating that I would be responsible for payment if my insurance carrier did not pay. Well, you didn't give my insurance carrier the opportunity to pay because you refused to file the claims in your name. The judge said that he could not force you to file the claims in your name, therefore he had no choice but to rule in your favor.



8. After you received the judgment, I contacted your office SEVERAL times, but you refused to speak with me. I was trying to make payment arrangements, but you instead had my wages garnished. You wouldn't even speak with me about making payment arrangements and now I am suffering severe financial difficulties due to the garnishment. And as if that wasn't enough, you are now suing me AGAIN for $15,0000 for slander, oral defamation, and libel. All I've done is tell the truth! I feel that my consumer rights have been violated and I am seeking help in any way I can. I can't afford to have my wages garnished and I can't afford to pay you $15,000, but as I told you in my email, I will continue to tell my story, THE TRUTH, to anyone who is willing to listen.



9. I did contact my insurance carrier, along with several other agencies, to have you investigated for fraud. The insurance carrier came back to me stating that the case was being closed, BUT, the investigator told me that the case was closed because you filed the claim stating that my injuries were due to a third party liability therefore I needed to seek restitution from the other party. I was then advised by the investigators manager to file a grievance with the insurance carrier, which is what I am in the process of doing. I am also waiting to hear from the other agencies that are investigating you. If the results are the same, then at least I can say I tried. I feel that I was wronged and I just don't want to see this type of thing happen to any other unsuspecting consumers. Most people, like myself, depend on their health insurance to pay their medical bills. I have not tried to AVOID my financial obligation at all. Like I told you in the mediators office when you sued me the first time, if I am indeed responsible for any of the bills, I will be more than happy to pay them, but not until my case was heard. You won fare and square so I tried to make arrangements to pay you. You would never call me and you had my wages garnished instead. How can you even make the statement that I am attempting to avoid my financial obligation? I even called you and explained the hardship that the garnishments were causing me and you were willing to stop the garnishment. Then you found out that you were being investigated again and not only did you back out of our agreement, you sue me for even MORE money? Well Dr. Sadri, if you win this next case, then I guess I'll owe you for the rest of my life. You can't squeeze blood out of a turnip! Maybe by then some other possible victims will have come forward, or maybe someone out there has had something similar happen to them and we can work together to try to change the way the system works. We'll just have to see. But if a doctor tells a person that they accept your insurance, they are a participating provider, and they will file your claims for you, then that's exactly what should happen. If any doctor can tell any patient "yes, I accept you insurance" knowing that they are NOT EVEN a network provider, then they file the claims in another doctors name, I'm sure that this will happen again and the situation may be worse for the next victim! It's not right, it's just not right...

Hi, I'm Erica, the person who wrote the original report. I'd like to clarify a few things.



1. When I entered your office in 12/2002, if you were not a participating provider, then why did you say you were? Did you lie to me? I specifically asked this question because I have HMO insurance. It is my responsibility to MAKE SURE that any healthcare provider whose services I seek IS a participating provider or my claims won't get paid. In all of my years, I always check first to make sure I am utilizing a participating providing and you said that you were. Your office accepted my insurance card, made copies, then told me that my claims would be filed at the end of my treatment. I had every reason to believe that you were a participating provider. In fact, my insurance carrier told me that you were a participating provider in 2002. I am in the process of filing a grievance with them (as suggested by THEIR fraud investigator) for giving me incorrect information if indeed it was incorrect.



2. Yes, your offices policies were explained to me, but I was never told that I would be under the care of the other doctor. I specifically asked for you when I came to your office and my very first appointment was with you. Why would you put me under the care of another doctor without my consent?



3. Your statement that "there were no benefits available and therefore the patient had to be held responsible for the entire balance" is not true. Chiropractic benefits have always and still are available to me, I just have to use a participating provider. That's why I made my appointment with YOU. I was told that you were a participating provider!



4. You are correct in stating that I refused to pay the bills that you kept sending me. First of all, my insurance carrier told me NOT to pay you anything because you were under investigation. If you were a participating provider then you needed to be paid by them, not me. Second, my insurance carrier told me that the bills WOULD be paid if you filed them under your name (you were on the phone when they said it). They refused to put it in writing therefore you refused to refile the claims in your name. Since the claims were filed under a non-participating providers name, of course they were denied!



5. I did not file the original complaint with my insurance carrier, it was filed on my behalf by the customer service rep that I had explained my situation to. It was then that you called me asking me to "call off the dogs". Do you remember saying that? You even told me that you would be willing to dismiss all of my bills and reduce my balance to $0. You said that this happens all the time and sometimes doctors have to take a loss. Well, I held up my end of the agreement and called my insurance carrier to ask them to stop the investigation, but I was told that I couldn't because I was not the one who requested that the investigation be started in the first place. It was out of my hands, but at least I did call them like I said I would. You, on the other hand, did not stick to your end of the agreement and you started billing me a few months later. I refused to pay anything, even the co-pays, until you filed the claims under your name, which you never did. Why wouldn't you just file the claims under your name? Were you afraid they would get paid?



6. Your statement "She continued to push the issue with her insurance and insisted that they further investigate this matter." is incorrect. I wasn't pushing the issue with my insurance carrier, I was pushing it with you! I NEVER insisted that they further investigate the matter, in fact, I wasn't the one who initially asked them to investigate the matter (as I stated above). You were the one who sent the information directly to the third party company and they denied them. When I called them to find out why they denied them, I was told that NO claims were EVER filed with them through my insurance carrier. You sent them the information, it was reviewed, and a letter was written. But I was told by this third party company that the letter never should have been written because the claim was NEVER filed with them through my insurance carrier.



7. You sued me in civil court and the only reason you won was because I signed a document stating that I would be responsible for payment if my insurance carrier did not pay. Well, you didn't give my insurance carrier the opportunity to pay because you refused to file the claims in your name. The judge said that he could not force you to file the claims in your name, therefore he had no choice but to rule in your favor.



8. After you received the judgment, I contacted your office SEVERAL times, but you refused to speak with me. I was trying to make payment arrangements, but you instead had my wages garnished. You wouldn't even speak with me about making payment arrangements and now I am suffering severe financial difficulties due to the garnishment. And as if that wasn't enough, you are now suing me AGAIN for $15,0000 for slander, oral defamation, and libel. All I've done is tell the truth! I feel that my consumer rights have been violated and I am seeking help in any way I can. I can't afford to have my wages garnished and I can't afford to pay you $15,000, but as I told you in my email, I will continue to tell my story, THE TRUTH, to anyone who is willing to listen.



9. I did contact my insurance carrier, along with several other agencies, to have you investigated for fraud. The insurance carrier came back to me stating that the case was being closed, BUT, the investigator told me that the case was closed because you filed the claim stating that my injuries were due to a third party liability therefore I needed to seek restitution from the other party. I was then advised by the investigators manager to file a grievance with the insurance carrier, which is what I am in the process of doing. I am also waiting to hear from the other agencies that are investigating you. If the results are the same, then at least I can say I tried. I feel that I was wronged and I just don't want to see this type of thing happen to any other unsuspecting consumers. Most people, like myself, depend on their health insurance to pay their medical bills. I have not tried to AVOID my financial obligation at all. Like I told you in the mediators office when you sued me the first time, if I am indeed responsible for any of the bills, I will be more than happy to pay them, but not until my case was heard. You won fare and square so I tried to make arrangements to pay you. You would never call me and you had my wages garnished instead. How can you even make the statement that I am attempting to avoid my financial obligation? I even called you and explained the hardship that the garnishments were causing me and you were willing to stop the garnishment. Then you found out that you were being investigated again and not only did you back out of our agreement, you sue me for even MORE money? Well Dr. Sadri, if you win this next case, then I guess I'll owe you for the rest of my life. You can't squeeze blood out of a turnip! Maybe by then some other possible victims will have come forward, or maybe someone out there has had something similar happen to them and we can work together to try to change the way the system works. We'll just have to see. But if a doctor tells a person that they accept your insurance, they are a participating provider, and they will file your claims for you, then that's exactly what should happen. If any doctor can tell any patient "yes, I accept you insurance" knowing that they are NOT EVEN a network provider, then they file the claims in another doctors name, I'm sure that this will happen again and the situation may be worse for the next victim! It's not right, it's just not right...

Hi, I'm Erica, the person who wrote the original report. I'd like to clarify a few things.



1. When I entered your office in 12/2002, if you were not a participating provider, then why did you say you were? Did you lie to me? I specifically asked this question because I have HMO insurance. It is my responsibility to MAKE SURE that any healthcare provider whose services I seek IS a participating provider or my claims won't get paid. In all of my years, I always check first to make sure I am utilizing a participating providing and you said that you were. Your office accepted my insurance card, made copies, then told me that my claims would be filed at the end of my treatment. I had every reason to believe that you were a participating provider. In fact, my insurance carrier told me that you were a participating provider in 2002. I am in the process of filing a grievance with them (as suggested by THEIR fraud investigator) for giving me incorrect information if indeed it was incorrect.



2. Yes, your offices policies were explained to me, but I was never told that I would be under the care of the other doctor. I specifically asked for you when I came to your office and my very first appointment was with you. Why would you put me under the care of another doctor without my consent?



3. Your statement that "there were no benefits available and therefore the patient had to be held responsible for the entire balance" is not true. Chiropractic benefits have always and still are available to me, I just have to use a participating provider. That's why I made my appointment with YOU. I was told that you were a participating provider!



4. You are correct in stating that I refused to pay the bills that you kept sending me. First of all, my insurance carrier told me NOT to pay you anything because you were under investigation. If you were a participating provider then you needed to be paid by them, not me. Second, my insurance carrier told me that the bills WOULD be paid if you filed them under your name (you were on the phone when they said it). They refused to put it in writing therefore you refused to refile the claims in your name. Since the claims were filed under a non-participating providers name, of course they were denied!



5. I did not file the original complaint with my insurance carrier, it was filed on my behalf by the customer service rep that I had explained my situation to. It was then that you called me asking me to "call off the dogs". Do you remember saying that? You even told me that you would be willing to dismiss all of my bills and reduce my balance to $0. You said that this happens all the time and sometimes doctors have to take a loss. Well, I held up my end of the agreement and called my insurance carrier to ask them to stop the investigation, but I was told that I couldn't because I was not the one who requested that the investigation be started in the first place. It was out of my hands, but at least I did call them like I said I would. You, on the other hand, did not stick to your end of the agreement and you started billing me a few months later. I refused to pay anything, even the co-pays, until you filed the claims under your name, which you never did. Why wouldn't you just file the claims under your name? Were you afraid they would get paid?



6. Your statement "She continued to push the issue with her insurance and insisted that they further investigate this matter." is incorrect. I wasn't pushing the issue with my insurance carrier, I was pushing it with you! I NEVER insisted that they further investigate the matter, in fact, I wasn't the one who initially asked them to investigate the matter (as I stated above). You were the one who sent the information directly to the third party company and they denied them. When I called them to find out why they denied them, I was told that NO claims were EVER filed with them through my insurance carrier. You sent them the information, it was reviewed, and a letter was written. But I was told by this third party company that the letter never should have been written because the claim was NEVER filed with them through my insurance carrier.



7. You sued me in civil court and the only reason you won was because I signed a document stating that I would be responsible for payment if my insurance carrier did not pay. Well, you didn't give my insurance carrier the opportunity to pay because you refused to file the claims in your name. The judge said that he could not force you to file the claims in your name, therefore he had no choice but to rule in your favor.



8. After you received the judgment, I contacted your office SEVERAL times, but you refused to speak with me. I was trying to make payment arrangements, but you instead had my wages garnished. You wouldn't even speak with me about making payment arrangements and now I am suffering severe financial difficulties due to the garnishment. And as if that wasn't enough, you are now suing me AGAIN for $15,0000 for slander, oral defamation, and libel. All I've done is tell the truth! I feel that my consumer rights have been violated and I am seeking help in any way I can. I can't afford to have my wages garnished and I can't afford to pay you $15,000, but as I told you in my email, I will continue to tell my story, THE TRUTH, to anyone who is willing to listen.



9. I did contact my insurance carrier, along with several other agencies, to have you investigated for fraud. The insurance carrier came back to me stating that the case was being closed, BUT, the investigator told me that the case was closed because you filed the claim stating that my injuries were due to a third party liability therefore I needed to seek restitution from the other party. I was then advised by the investigators manager to file a grievance with the insurance carrier, which is what I am in the process of doing. I am also waiting to hear from the other agencies that are investigating you. If the results are the same, then at least I can say I tried. I feel that I was wronged and I just don't want to see this type of thing happen to any other unsuspecting consumers. Most people, like myself, depend on their health insurance to pay their medical bills. I have not tried to AVOID my financial obligation at all. Like I told you in the mediators office when you sued me the first time, if I am indeed responsible for any of the bills, I will be more than happy to pay them, but not until my case was heard. You won fare and square so I tried to make arrangements to pay you. You would never call me and you had my wages garnished instead. How can you even make the statement that I am attempting to avoid my financial obligation? I even called you and explained the hardship that the garnishments were causing me and you were willing to stop the garnishment. Then you found out that you were being investigated again and not only did you back out of our agreement, you sue me for even MORE money? Well Dr. Sadri, if you win this next case, then I guess I'll owe you for the rest of my life. You can't squeeze blood out of a turnip! Maybe by then some other possible victims will have come forward, or maybe someone out there has had something similar happen to them and we can work together to try to change the way the system works. We'll just have to see. But if a doctor tells a person that they accept your insurance, they are a participating provider, and they will file your claims for you, then that's exactly what should happen. If any doctor can tell any patient "yes, I accept you insurance" knowing that they are NOT EVEN a network provider, then they file the claims in another doctors name, I'm sure that this will happen again and the situation may be worse for the next victim! It's not right, it's just not right...

Hi, I'm Erica, the person who wrote the original report. I'd like to clarify a few things.



1. When I entered your office in 12/2002, if you were not a participating provider, then why did you say you were? Did you lie to me? I specifically asked this question because I have HMO insurance. It is my responsibility to MAKE SURE that any healthcare provider whose services I seek IS a participating provider or my claims won't get paid. In all of my years, I always check first to make sure I am utilizing a participating providing and you said that you were. Your office accepted my insurance card, made copies, then told me that my claims would be filed at the end of my treatment. I had every reason to believe that you were a participating provider. In fact, my insurance carrier told me that you were a participating provider in 2002. I am in the process of filing a grievance with them (as suggested by THEIR fraud investigator) for giving me incorrect information if indeed it was incorrect.



2. Yes, your offices policies were explained to me, but I was never told that I would be under the care of the other doctor. I specifically asked for you when I came to your office and my very first appointment was with you. Why would you put me under the care of another doctor without my consent?



3. Your statement that "there were no benefits available and therefore the patient had to be held responsible for the entire balance" is not true. Chiropractic benefits have always and still are available to me, I just have to use a participating provider. That's why I made my appointment with YOU. I was told that you were a participating provider!



4. You are correct in stating that I refused to pay the bills that you kept sending me. First of all, my insurance carrier told me NOT to pay you anything because you were under investigation. If you were a participating provider then you needed to be paid by them, not me. Second, my insurance carrier told me that the bills WOULD be paid if you filed them under your name (you were on the phone when they said it). They refused to put it in writing therefore you refused to refile the claims in your name. Since the claims were filed under a non-participating providers name, of course they were denied!



5. I did not file the original complaint with my insurance carrier, it was filed on my behalf by the customer service rep that I had explained my situation to. It was then that you called me asking me to "call off the dogs". Do you remember saying that? You even told me that you would be willing to dismiss all of my bills and reduce my balance to $0. You said that this happens all the time and sometimes doctors have to take a loss. Well, I held up my end of the agreement and called my insurance carrier to ask them to stop the investigation, but I was told that I couldn't because I was not the one who requested that the investigation be started in the first place. It was out of my hands, but at least I did call them like I said I would. You, on the other hand, did not stick to your end of the agreement and you started billing me a few months later. I refused to pay anything, even the co-pays, until you filed the claims under your name, which you never did. Why wouldn't you just file the claims under your name? Were you afraid they would get paid?



6. Your statement "She continued to push the issue with her insurance and insisted that they further investigate this matter." is incorrect. I wasn't pushing the issue with my insurance carrier, I was pushing it with you! I NEVER insisted that they further investigate the matter, in fact, I wasn't the one who initially asked them to investigate the matter (as I stated above). You were the one who sent the information directly to the third party company and they denied them. When I called them to find out why they denied them, I was told that NO claims were EVER filed with them through my insurance carrier. You sent them the information, it was reviewed, and a letter was written. But I was told by this third party company that the letter never should have been written because the claim was NEVER filed with them through my insurance carrier.



7. You sued me in civil court and the only reason you won was because I signed a document stating that I would be responsible for payment if my insurance carrier did not pay. Well, you didn't give my insurance carrier the opportunity to pay because you refused to file the claims in your name. The judge said that he could not force you to file the claims in your name, therefore he had no choice but to rule in your favor.



8. After you received the judgment, I contacted your office SEVERAL times, but you refused to speak with me. I was trying to make payment arrangements, but you instead had my wages garnished. You wouldn't even speak with me about making payment arrangements and now I am suffering severe financial difficulties due to the garnishment. And as if that wasn't enough, you are now suing me AGAIN for $15,0000 for slander, oral defamation, and libel. All I've done is tell the truth! I feel that my consumer rights have been violated and I am seeking help in any way I can. I can't afford to have my wages garnished and I can't afford to pay you $15,000, but as I told you in my email, I will continue to tell my story, THE TRUTH, to anyone who is willing to listen.



9. I did contact my insurance carrier, along with several other agencies, to have you investigated for fraud. The insurance carrier came back to me stating that the case was being closed, BUT, the investigator told me that the case was closed because you filed the claim stating that my injuries were due to a third party liability therefore I needed to seek restitution from the other party. I was then advised by the investigators manager to file a grievance with the insurance carrier, which is what I am in the process of doing. I am also waiting to hear from the other agencies that are investigating you. If the results are the same, then at least I can say I tried. I feel that I was wronged and I just don't want to see this type of thing happen to any other unsuspecting consumers. Most people, like myself, depend on their health insurance to pay their medical bills. I have not tried to AVOID my financial obligation at all. Like I told you in the mediators office when you sued me the first time, if I am indeed responsible for any of the bills, I will be more than happy to pay them, but not until my case was heard. You won fare and square so I tried to make arrangements to pay you. You would never call me and you had my wages garnished instead. How can you even make the statement that I am attempting to avoid my financial obligation? I even called you and explained the hardship that the garnishments were causing me and you were willing to stop the garnishment. Then you found out that you were being investigated again and not only did you back out of our agreement, you sue me for even MORE money? Well Dr. Sadri, if you win this next case, then I guess I'll owe you for the rest of my life. You can't squeeze blood out of a turnip! Maybe by then some other possible victims will have come forward, or maybe someone out there has had something similar happen to them and we can work together to try to change the way the system works. We'll just have to see. But if a doctor tells a person that they accept your insurance, they are a participating provider, and they will file your claims for you, then that's exactly what should happen. If any doctor can tell any patient "yes, I accept you insurance" knowing that they are NOT EVEN a network provider, then they file the claims in another doctors name, I'm sure that this will happen again and the situation may be worse for the next victim! It's not right, it's just not right...

The fact is (and unlike the individual reporting this matter, we have EVERY document supporting our position) that when this individual entered our office in 12/2002 we (NONE of the doctors in our practice) were participating providers for her particular insurance company and therefore, none of our names COULD HAVE or WOULD HAVE been in ANY provider plan books! In addition, ALL our office's financial policies were explained to her verbally AND in writing. All of which she signed.



Just as many multi-doctor practices operate, her case was assigned to one of the doctors in the practice, who in turn became her "attending physician" and thereby all her care was prescribed and supervised by that particular doctor. During her treatment with us, myself and two other providers assisted in administering the care that her attending physician had prescribed for her, meaning that a total of 4 providers contributed and assisted in the course of her treatment.



It is true that we took and copied her insurance card. That is standard procedure in our office. It is also true that we accepted, and still do, her particular insurance. However, every individual policy is different and depending upon the type of plan a person has, they MAY or MAY NOT have benefits available for the type of care they seek. In this particular case, there were NO benefits available and therefore the patient had to be held responsible for the entire balance.



As we continued to bill this individual for her balance she kept insisting that we should bill her insurance and that THEY are the ones who should pay. She also insisted that we should send her bills under MY name, one of 4 providers who helped in her treatments, because I was now (as of 1/1/2003) a participating provider with her insurance company. Her original claims were submitted to her insurance company and they did reflect the name of the doctor who was in charge of her care at our office (who IS NOT a participating provider with her insurance). They were naturally denied. She continued to insist that we should file her claims under MY name and she filed a complaint with her insurance company. They in turn contacted our office and inquired about the details. We explained everything as is explained here and they determined that we had done everything correctly in doing our billing the way we did and that they would not pay for any of her claims.



She continued to push the issue with her insurance and insisted that they further investigate this matter. They in turn requested that we send a copy of her complete records to a third party to review. We did. The review report came back and indicated in clear language that this patient's claims are NOT ELIGIBLE for payment regardless of whether her treatments were provided by an "IN-NETWORK" or an "OUT-OF-NETWORK" provider meaning that ONLY SHE is responsible for the payment of her bills. She still refused to accept this and would not make any payments on her account. During this process we also told her insurance company that, if they think it appropriate, we would break her billing down and that we would bill the specific dates of services rendered by various providers and that we would accept in-network rates for the same. Their reply was for us to send everything "as is" to the third party reviewer, which we did.



We also requested; assuming that this patient was indeed correct in what she was claiming about her insurance being responsible, that she at least pay her co-pays on the account. After all, if she indeed did have benefits it would not cover her co-pays. She still refused to make any payments of any type! We were then forced to take legal action against her. The judge reviewed the facts and documents and ruled in our favor. He also indicated to her that if she thinks we had done anything illegal, that she should hire a lawyer and pursue that matter from there.



Even with a judgment in hand, she still refused to make any payments. Left with no other options, we then pursued garnishment of her wages. She in turn filed a complaint with the Better Business Bureau against me/us. They indicated that this matter, having been through the courts already, was outside what they do. She then filed a complaint with the Ethics Committee of our state association. They requested and received the documentations in her file from us. They ALSO determined that we had NOT DONE ANYTHING WRONG and that SHE is responsible for her bill and recommended that she should pay it.



Being unhappy with the outcome of all her efforts, she then reported me to the "Fraud and Abuse" department of her insurance company. They contacted our office and I, once again gave the details of the case. We indicated that ANY and ALL of the supporting documents in this case are available and offered to send them. The investigator indicated that that would not be necessary and that there was NO FRAUD and NO ABUSE there to be investigated and that he was permanently closing the file on this case.



She, now having been told by ALL who she had complained to that SHE is responsible for her bill and that WE HAD DONE NOTHING ILEEGAL OR UNETHICAL, sent us an email indicating that she plans to file complaints/reports with any and all entities she can. This, I am sure, will result in an outcome no different than what she has accomplished to this point. We provided her services in good faith, expecting that we would be paid for our work. We complied with every request from every entity who has been involved in this process. They ALL came to the same conclusion indicating that we were right in what we did and that she should pay her bill.



This complaint is no different that all her other unsuccessful attempts to avoid her financial obligation.

The problem started with the lawyer who sent you to Dr. Sadri. He is crooked, along with the doctor. This is a common scheme. The doctor pays the lawyer a kickback for sending accident victims to him. Then the doctor trumps up large bills, though the victim doesn't complain much at this stage because he or she's expecting to win a big settlement. When that doens't happen (in part because the crooked lawyer is also lazy and doesn't fight to get it), the doctor tries to collect all the bogus money from the victim instead.



If you are still using the first lawyer, fire him and report him. For everyone else reading, whenever a personal injury lawyer tries to send you to a specific doctor, it's a scam. Get out of there. Never see that lawyer or doctor again. If you are injured in an accident, go to your regular doctor or others that he or she recommends. If you don't have a regular doctor, ask friends and family to recommend one, or just pick one out of the phone book. Never ask a lawyer! Next if you have health insurance, use it. If you do win a settlement later, the health insurance company is allowed to recover the money they paid for your treatment from it. But this will be much less money than the doctor would've billed you directly. If a doctor is refusing to submit his bills to your health insurance, send them in directly yourself. And look for another doctor, you've got a crooked one.



Erica needs to get another lawyer if she hasn't already. It should be possible to get the judgement thrown out because the doctor committed fraud. The first lawyer is obviously not going to pursue that. Also talk to Blue Cross and use the "F" word a lot. Insurance companies really don't like any hint of fraud.

I work for a major insurance company and I have personally had this facility flagged for their billing practices and some of the procedures they have performed. I'm not sure what the judge who oversaw your case was smoking, but if this "doctor" (a stretch of a designation for chiropractors as far as I'm concerned)was the physician who performed the procedures on you and he submitted them under a different physician's name to your insurance company, that's FRAUD and you should contact your insurance company's Special Investigations Unit (SIU). They may have reports from other insureds on him, and they have a system where they interact with other insurance companies (like mine) and others may have a report on him. Your attorney should ask for a copy of your treatment records (if you don't already have one)because the physician has to sign his records. If he didn't sign them or it shows his name was on the records but they were billed under a different physician's name as you state (of which your insurance company will have the original claim), that's a very good start. The only way we can catch these doctors is if patients report incidents like this to your insurance company. Good luck.