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theicebrg | A hospital is charging me the full amount; what should I do? |
I called a hospital, and it said it took my insurance. I went to the hospital, and they charged me the entire amount. The reason is that my insurance actually turns out not to cover that hospital. When I told the hospital it wasn't fair that they made a false statement, they responded by saying it was my duty to have asked my insurance provider instead of the hospital beforehand. Is the hospital right, or do I have a legal theory to recover?
Additional Details
Okay guys, you all seem to be in agreement that the hospital wins. Thanks for the help.
It's a really sorry situation. When I asked them if they would take my insurance, they should have just told me to ask the insurance company. They shouldn't have told me that they do. That's not right.
That's why I think it's different from the scenario someone described below with the meal. If I go to McDonald's and ask if a burger is free, and someone tells me yes, and then I eat it, they can't charge me a dollar for it. The menu may say a dollar, but the price they agreed to was "free".
I just can't believe that in this situation there is no estoppel, no detrimental reliance, false advertising, misrepresentation or anything. They shouldn't be allowed to claim to accept my insurance and then stick me with the bill.
But, you guys are in agreement. Thanks for the help. For more than just the fact that they don't take my insurance, I won't ever go to that hospital again. |
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bud68
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The hospital is correct. It is your responsibility to verify with your insurer. Never take the word of clerks or provider/hospital staff.
If it was emergency service, you can appeal the denial to your insurer. Other than that, you're stuck. |
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Beau.Gus
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Unfortunately, it is your responsibilty.
It's no different than if you went into a restaurant and ate a meal because you THOUGHT you had the money to pay for the food.
The hospital DOES take that kind of insurance, your beef should be with the insurance company who apparently do not cover whatever treatment you had. And it was up to you to read your policy and understand what is and is not covered...
Sorry!
If you explain the situation to the hospital billing office they will help you work out a payment plan, they deal with this sort of thing every day... |
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sarah314
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It is ultimately the patient's responsibility to verify the network status of any provider directly with the insurance company.
Also, did the hospital tell you that they "take" your insurance, or did they tell you that they are an "in-network provider"? Those statements definitely don't mean the same thing!
"Taking" an insurance plan means that they will allow you as a patient, bill your insurance company, and bill you for your liability after the insurance company pays whatever they are going to pay.
Being an "in-network provider" means that your insurance company will process a claim for that provider according to the highest benefit level of your plan, and the hospital will not balance bill you for anything other than what your insurance says is patient liability.
I'd suggest checking with the hospital to see if they will work with you on a self-pay discount and payment plan for the amount that is remaining as your responsibility. And next time, make sure you confirm with your insurance company that a provider is in-network! |
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debijs
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~~This is a very common problem in the medical field. All medical offices and hospitals should refer you to your insurance company to answer your questions.
I always tell everyone, before you see anyone, have any tests done, etc. check your benefit book or just call the customer service number on the back of your insurance card. Always make a note of the person who gave you the information, date and time.
This is the only way you can protect yourself from getting a very unexpected (and expensive bill). There is no other protection for you.
Be sure and keep all medical payment receipts. At least it can be a write of on your income tax, in that's any consolation at all.~~
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J
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Yup I've been through this and I know better than to trust the hospital. You have to call your insurance provider and be absolutely sure the hospital and physician are *in-network*. Accepting the insurance isn't necessarily the same as being in-network. Never take the hospital's word. Sorry you had to learn the hard way. BCBS would only pay 50% in this case. |
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katiesquilts
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Was it an emergency? If it was, your insurance may still cover some of it. If not, then find out if the hospital WAS in your network but recently dropped out. If it did, then you may be able to convince them to cover the charges as well.
It is always your responsibility as the participant to confirm the participation of a provider/hospital. Good luck! |
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