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Subject:
Health insurance dispute
Category: Health Asked by: brianmcg-ga List Price: $5.00 |
Posted:
27 Oct 2005 10:47 PDT
Expires: 26 Nov 2005 09:47 PST Question ID: 585703 |
My wife and I are having a dispute with our health insurance company regarding surgery that my wife had this past summer. The insurance company is only paying for approximately 1/3 of the anasthesiologist's bill, and we are being invoiced by the hospital for over $2,500. After many phone calls, I found out that the reason why was because the doctor and/or the hospital chose an anastehsiologist that was out of network. Of course, we had no input into this decision and were never told ahead of time that this may happen. The insurance company isn't budging and the hospital hasn't been any help. Is there anything I can do to fight this? If I do not pay this invoice, what will happen? |
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There is no answer at this time. |
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Subject:
Re: Health insurance dispute
From: charliebabbage-ga on 27 Oct 2005 16:05 PDT |
I assume that you live in the US. In the UK we have the Insurance Ombudsman Bureau which will independently adjuticate in disputes between policyholders and insurance companies. Do you have anything similar in the US? If not, you could consider suing the insurer but their policy conditions will probably prevent you being successful. If you refuse to pay the hospital, ultimately they could sue you for the full amount they are claiming. |
Subject:
Re: Health insurance dispute
From: mellowyellow-ga on 28 Oct 2005 21:16 PDT |
What state do you live in? Who is the insurer? Do you have all the documents you signed for the admission and procedure? |
Subject:
Re: Health insurance dispute
From: dickg-ga on 29 Oct 2005 09:53 PDT |
I recently had a somewhat similar occurrence--but double the amount in which you owe--you have an accurate picture. This is what I know and it may be redundant-- -Networked providers are health care professionals who agree to bill the insurer at a set amount. When one goes outside that network--there is no implied cost containment. On the good side this helps to keep costs down. -First --Check your policy--was the surgery outpatient or inpatient? My wife was in the hospital for three days and it was considered outpatient surgery. Different sets or rules may apply here. Make sure that this is not a "preauthorization" problem as opposed to a "out of network" problem. These can be different problems with different solutions. -Second-The Insurer will be the unlikely party to give any here. If you read your policy there will be a disclaimer about going outside of the network. You are legally responsible for the unpaid balance. -Third--Go to your Dr/Hospital. Or more specifically the business agent/accounts manager who handles the insurance--explain the problem. Keep coming back to them. Why are they charging more than the network approved fees?? Tell them you can't afford these costs. Ask them if they can offer you a compromise. Your hammer here is if you default on this they get nothing. But you are responsible for this cost and they could damage your credit. Be assertive, persistent without being antagonistic. Tell them that you want to do the right thing but this is just too much money. -Four-Go to you Insurance company--get the names of a few network medical providers. Call their business manager up and explain the situation and ask them what they would charge for this procedure. Are the network fees that the Insurer is allowing truly inline with what they say they will pay??? If there are significant difference see pt. five, six -five-Get your insurance agent involved. They are a resource here. See if they can offer any help. They might be able to help you with pt. four. -six-Every state has an state insurance board but I don't think they will be much help since this is not a case of fraudlent practice on the insurer's part. unless pt. four shows some discrepancy. -seven-As a court of last resort--look at the arbitration clause in your policy. It would require a lawyer and you would have to have grounds to be successful in this but it is a possibility esp. if the numbers don't add up as per pt.four. In summary--your best chance for successful resolution is pt. three. Be persistent but polite. I had a buddy that was told that he owed $1,700 afterthe Insurer paid their part. He went back to the Dr.s office and they forgave all but $100 but he had to be persistence. -Good luck- DickG |
Subject:
Re: Health insurance dispute
From: candiebar-ga on 22 Nov 2005 13:16 PST |
Well if I were you I would star looking for an attorney. My husband & I are going threw something similar. The clinic has filled a judgement against us and the courts are now garnishing his wages. Even after my husbands employer sent a letter to the insurance telling them to pay they refuse. We have secured an attorney and he has sent a letter demanding payment with in 15 days or we will be pressing charges. We will see how it goes. |
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