Insurance Co changes $$ covered after service

[Frank The Blade]

What is the name of your state (only U.S. law)? Texas

I recently had a sleep study. The clinic reviewed the study with insurance and determined I was only responsible for $60 co pay which I paid at time of service. Subsequently I was presented with a $400 bill for services insurance didn't cover. The clinic said originally they were told everything was covered except for $60 co pay. I signed a statement to the effect "I am responsible for charges not covered by insurance..." beneath which was a blank stating this amount was $60.

I've tried to discuss with clinic but they won't return calls. I sent registered letter stating I can't be responsible for costs that I am not made aware of prior to service. I feel it's their mistake and the form I signed was confirming I was responsible for the $60 that wasn't covered by insurance.

The clinic is threatening to turn over to a collection agency. Am I responsible and what are my options

 

[Zigner]

What is the name of your state (only U.S. law)? Texas

I recently had a sleep study. The clinic reviewed the study with insurance and determined I was only responsible for $60 co pay which I paid at time of service. Subsequently I was presented with a $400 bill for services insurance didn't cover. The clinic said originally they were told everything was covered except for $60 co pay. I signed a statement to the effect "I am responsible for charges not covered by insurance..." beneath which was a blank stating this amount was $60.

I've tried to discuss with clinic but they won't return calls. I sent registered letter stating I can't be responsible for costs that I am not made aware of prior to service. I feel it's their mistake and the form I signed was confirming I was responsible for the $60 that wasn't covered by insurance.

The clinic is threatening to turn over to a collection agency. Am I responsible and what are my options

Yes. Why? Because you agreed to be.
Options? Pay the bill...or don't.

 

[ecmst12]

It is impossible to predict with 100% accuracy how a claim will be processed before it is submitted. You are responsible for the bill whether you knew about it ahead of time or not. Now, have you talked to your insurance company to find out what the extra $400 is for and why it isn't covered?

 

[lealea1005]

When the provider calls the insurance company for verfication of coverage, they are immediately met with a recorded disclaimer which states (or close to it) "Verficiation of coverage is not a guarantee of payment."

I cannot count the times we are given the wrong information regarding a patient's coverage by an insurance company. The provider was only repeating the information given to him/her by your insurance company.

You are responsible for the bill and I'll bet, dollars to donuts, that responsibility is indicated somewhere on your EOB or in your policy.