Hospital is suing me over my bill for giving me out of network doctor without my cons

[linkavb]

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

I went to an Emergency room in January of 2013. I have my own personal Healthcare insurance that I pay for per month. My annual deductible is $5200.
At the time of the service in ER, a woman from the hospital walked into my room and had me sign a paper saying "I agree to hold financial responsibility" I've asked her what am I signing since it was written in size 4 font (very small) and 2 pages long and she looked like she wasn't going to wait till I read what she gave me to sign (my fault). I was also not in very good condition (I had high fever and bronchitis) and my lungs were in danger (because I had severe lung damage in 2009 and had ARDS Acute Respiratory Distress Syndrome when lungs collapse).
Anyway, I signed and a doctor walked in.

The doctor did not say that he was NOT associated with the hospital. The doctor was wearing hospital's scrabs and was wearing Hospital's ID tag with his name. The doctor visited me only twice while I was in ER (and I was there for 4 + hours)
The doctor also did not say that he was IN my insurance network. Nobody told me he was OUT of my network. However the hospital IS in my insurance network. Since the doctor was wearing hospital's scrabs/hospital's badge there was nothing that would make me think twice that he was NOT in my insurance network! If he had different uniform (another color) it would've crossed my mind to ask him...

So now 5 months AFTER my visit, I receive by mail my first bill which says I have to pay THEM $593 for his services. I call in....I have an "account" with a hospital. It's a medical bill account that's how I pay my medical bills and they now excel over $10,000 mark (I have been very sick since 2009) and I am not even 40 years old yet. Anyway, I ask this company that billed me (btw the company has almost same name as the hospital, only instead of a word "hospital" it says "Emergency Physicians") I ask them to transfer the bill to my "account" so i can make monthly payments as I have been paying monthly payments on my $10,000+ bill..... and they tell me this "We CANNOT transfer this bill over to your hospital's bank account because we are NOT affiliated with the hospital". You have to pay $593 at once. That's what they told me on Wednesday this week.

I call in today... talk to my insurance carrier and they tell me that I only owe them $254.84 that the other part of the bill was written off. But my statement says different... so my wonderful insurance agent has me on the phone and calls that company from ER Physicians. The co says that the doctor was NOT in network, the "written off" statement does NOT apply to my deductible or anything and that I need to pay it in FULL and they said that's TWO (2) days after my first phone call that this statement is now past due 90 days (and last month was when I'd received it for the first time) and because it's been past 90 days it's now in collection agency!! PLUS I was slammed with late fees as well!

What rights do I have? When one has true emergency and is given 2 papers to sign with size font of 4 points and the woman who gives papers to sign before the patient can be seen tells the patient "just a formality and that you'll pay the bill". The woman never mentioned that the doctor who is going to see me might be OUT OF MY NETWORK and that I'd have to pay full price for his service. Nobody told me that the doctor is NOT affiliated with the hospital and I won't be able to finance his charges either! I am currently not working due to health issues I've had. I only have one husband working with one income and I have a child at home under the age of 11 living as well. And these people who send me charges don't want to hear my stories, they are rude and threatening to sue me if I don't pay this bill right away. I don't know where the heck am I going to get $600....

Please help
Thanks

 

[ecmst12]

If this was an emergency and the doctor was not contracted, your insurance should not be trying to tell them to write ANYTHING off. You need to talk to your insurance company again.

Doctor bills are separate from hospital bills and you should already know that you get separate bills from each when you are treated in the hospital - every time.

 

[Ladyback1]

Dispute the bill in writing to all parties. Explain the situation as clearly as possible.

Some hospitals do run a system of "hospitalist" where the physicians who work in the hospital are hospital employees. However, many emergency rooms contract out for emergency physicians. And, yes, that does screw w/ insurance filing/claims.

 

[ecmst12]

If the insurance directed a writeoff to a non contracted provider, it's the insurance company that screwed up and needs to fix it.

 

[cbg]

Just a few points:

Unless it is specifically and in so many words spelled out in your insurance policy otherwise, it is 100% the responsibility of the patient to determine who is and is not in their specific insurance network. Every insurance carrier has more than one network; knowing that you have BCBS, for example, does NOT tell the doctor or the hospital which BCBS network you are on. Therefore, they do not necessarily know, right off the top of their heads, whether they are in or out of network for you, or which labs/radiologists/what-have-you are part of your network. You only have to keep track of you; they have hundreds of patients.

The doctor is not responsible for telling you how he is affiliated.

I promise you, both the hospital and the insurance carrier would love to make it mandatory that all their physicians and department be part of every insurance network they are affiliated with. They cannot. The doctors have the right of choice and unless it is specifically put into their contracts (which may be the case with interns and residents in teaching hospitals but will not be the case with attendings or any doctor in non-teaching hospitals) it is entirely up to the doctor which carriers they participate with. The same applies to third party labs and radiologists.

Submit the bills to the insurance carrier. Most managed care policies will pay the in-network percentage (whether it be 100%, 90%, 80%, whatever) of reasonable and customary fees for out of network providers when it it truly an emergency. The difference is, while they can stop an in-network provider from balance billing you, they have no authority to stop an out of network provider for billing you for anything not paid by the insurance. But unless the insurance policy specifically states that it is the responsibility of the provider to acertain who is and is not out of network and to ensure that you are only seen or treated by network facilities, then it is your responsibility to ask, not theirs to offer.