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.
Wilborn says she had no idea Eavenson had stopped billing her insurer. As a result, she was forced to pay his full bill without any reduction, according to the complaint. In addition, the insurance company may not pay her bills because all claims must be filed within a certain time period.
Wilborn says she was not the first person affected by Eavenson’s refusal to bill insurance companies. She claims he “has engaged in this conduct on a regular basis.”
In the two-count suit, Wilborn is seeking an accounting from Eavenson of her claim of efforts to bill her health carrier and an accounting of all other cases in which other people have been treated in the same manner. She is also asking for a refund of money she lost through Eavenson’s failure to timely bill Cigna and a refund of money for his failure to bill Cigna at the contracted rate.
She is represented by Thomas C. Rich and Jennifer L. Barbieri of Fairview Heights.
St. Clair County Circuit Court case number: 09-L-204.