A medical service provider can sue an individual covered by a health care plan though it is a sporadic occurrence. Incidences that drive a medical service provider to sue someone are failure to pay bills, disputes due to the amount of bill to be paid, or a situation where a health care plan does not cover certain levels of treatment. The most common scenario that warrants suing is when an individual has a high deductible health plan and has not yet met their deductible. In such occasions, the individual is responsible for paying the total cost of medical services from their pocket. If they fail to do so, the medical provider may seek legal help from legal institutions to recover the balance not paid.

Another scenario that warrants suing from the medical provider is when there is a dispute regarding the total bill. For example, the medical provider may overprice medical attention given to the patient or quote medication not performed on the patient; the patient might decline to pay the entire bill. In such cases, suing is the best approach medical service providers may use to recover the amount disputed.

An example of a medical service provider suing an individual covered with a health care plan was during the case of Sutter Health V. Superior Court (2018). The case was decided in the supreme court in California in 2020. In this case, Sutter health, a medical provider, sued an individual who had health insurance because BlueShield California provided low rates and had to pay the remaining amount. The court allowed the lawsuit to proceed and ruled in favor of stutter health.in summary, cases of suing an individual usually arise with failure to pay for services provided.

Reference

Sutter Health v. Superior Court, 5 Cal.5th 926 (2018)

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