Need help with health insurance question?

Question

Need assistance with advice involving health insurance?

Recently I incurred a health injury. Part of the perscription from my doctor consisted of Physical Therapy sessions. I chose to use my local county hospital. On my initial visit I arrived to the PT section of the hospital present my health insurance card and filled out the required forms. Then I has two visits of 30 min each for 3 weeks for a total of 6 visits. I received a bill from the hospital about 30 days later. The bill totaled $1800 with my insurance only paying $600 leaving a balance of $1200 for me to pay. My insurance plan provides for 80% payment not 30%! I called my insurance company to determine why the underpayment. They advised me it was due to the hospital staff not pre-authorizing the service.

Now, the hospital is sending me the bill insisting I pay the balance of $1200.

What are my rights? What course of action should I take?

Answer 1

So,a few of things you are supposed to think.I have had good experience here.......http://health-insurance.expert-tip.info/...

Answer 2

Sadly you don't have much recourse.  You can fight the charges with the Hospital, but it's not too likely you will win.  You can try to establish why the hospital permitted treatment without authorization from the insurance company, but they will likely turn it back on you.  The insurance company is covered in that they paid their portion so they are now out of the loop.

Good Luck with this one.

Answer 3

Clarify that with the insurance plan that you have. Usually the patient has to get pre-authorization.  The Hospital won't do that because they don't know that  your insurance requires it.

Answer 4

You needed to understand your policy before service...you will have to pay it.

Answer 5

Unfortunately, it is up to you to verify that you are using in-network providers and that any necessary preauthorization is obtained.  I have learned the hard way never to assume anything and never to take the verbal word of the ignorant medical receptionists.

Answer 6

WAIT!!!!  This can be negotiated!!! First thing you do is call the hospital (and insurance company) and ask them if there is anything they can do to "help" you with the bill, you could possibly get a discount. Next call the doctor directly and ask if there is anything he can do. The next thing to do is check your original benefit summary and make sure EVERYTHING is being paid for in the outline. Sometimes you can get coverage if it was related to an "emergency" as deemed by your doctor. Another step would be to contact your state insurance department and ask if there is any potential rule violation in your state. The state laws do vary quite a bit with health insurance so its hard to say what your specific options are. Last but not least BE NICE..... make a friend at each call.... it helps! I also have to be fair and tell you its quite possible it will end up getting you know where.... and if that happens? I would just pay it, and remember what goes around comes around. Good Luck!!!

Answer 7

You should always check if you need authorization before doing anything. Unfortunately you are responsible for the bill because it was your responsibility to find out if you needed authorization. You may be able to call the hospital and negotiate a lower cost because of the situation.