Hospital is threatening me and harassing me. They released my very personal informati

[tranquility]

I see many have sided with the hospital...

But... if I am (the patient) decided to go to xyz hospital for my choice who is clearly listed as my IN-NETWORK provider, I was expected to be covered 100% by my insurance co at that time since I had met my deductible for that year. If I had known that I'd be services by out of network doctor, I would've refused to receive his services.

Furthermore, with my recent visit to the hospital, I'd asked attending nurse to send us a doctor who's in our insurance network. She replied "ALL doctors who work at our hospital are in your insurance network" I told her my experience and she said she's never heard of a hospital employing a doctor especially in ER as an independent doctor and then charge the patient non discounted fee.

I will continue to "bark" at that tree because I believe I wasn't fairly served and the hospital placed me in financial strains. Now they've attached a barking dog at me who refuses to say of the phone what's she calling about yet she wants me to give out my first born's child name to some stranger that I've never met nor know over the phone in God knows what settings and who's been chewing gum when she was speaking with me.

Check out the thing I mentioned and then go to appeals. Get all your facts together and take it to the insurance company appeal process and also discuss things with the hospital. The hospital may have an ombudsman who can help. I have been where you were many times. I won. In preparing for if I lost and would have had to litigate matters, it surprised me how little case law there is on the matter so, if it gets to there, it depends on all the specific facts and claims to determine the result.

Good luck! But, for right now, focus on the bill and not the collector.

 

[tranquility]

You are personally liable for any debt incurred due to your visit. Your insurance provider has agreed, with you, to indemnify you per your contract. If they have refused to do so, it is an issue to be resolved with your insurance provider. If they can properly deny the claim, then it is as simple as the debt is yours to pay.

This is not auto insurance, but health insurance. The OP relied on the representation the hospital was a participating provider and would be covered by the contract. The contract is not just with the insured, but with the provider. If the doctor, nurse, technician, whoever or whatever service is not covered by the contract, the hospital may (I say may as I don't have any appellate case for on against in this specific situation.) have a duty to disclose it. Perhaps it is in the contract they signed with the insurance company.

 

[justalayman]

This is not auto insurance, but health insurance. The OP relied on the representation the hospital was a participating provider and would be covered by the contract. The contract is not just with the insured, but with the provider. If the doctor, nurse, technician, whoever or whatever service is not covered by the contract, the hospital may (I say may as I don't have any appellate case for on against in this specific situation.) have a duty to disclose it. Perhaps it is in the contract they signed with the insurance company.

I am speaking specifically to medical insurance.

Not sure what representation the OP was relying on unless the doc walked up and said; Hi, I'm Doc Gonnatakeyourspleenout, employee in good standing of this hospital.

The contract is not just with the insured, but with the provider.

that is a separate contract. One does not rule over the other and each controls over an action between the parties of the involved contract. I cannot demand the insurance company enforce the obligations of their contract with a provider. I can only demand enforcement of my contract with the provider.

If the doctor, nurse, technician, whoever or whatever service is not covered by the contract, the hospital may (I say may as I don't have any appellate case for on against in this specific situation.) have a duty to disclose it. Perhaps it is in the contract they signed with the insurance company

or perhaps in the admission paperwork the OP signed when completing the admission forms at the hospital such as what I paraphrased previously. That is quite common here.


but let me add:

I HATE how the system functions concerning this sort of issue. I completely agree with the feelings of the OP but that does not change how the system actually works.

but go back and read my quick description of why a hospital cannot be expected to ensure any given provider operating within their building is a PP of any given patient. It is just unrealistic to think it is a practical solution.

 

[tranquility]

that is a separate contract. One does not rule over the other and each controls over an action between the parties of the involved contract. I cannot demand the insurance company enforce the obligations of their contract with a provider. I can only demand enforcement of my contract with the provider.

This part does have case law. The insured is a third party beneficiary of the participating provider contract. He certainly can enforce the contract between the insurance company and the participating provider.

 

[justalayman]

This part does have case law. The insured is a third party beneficiary of the participating provider contract. He certainly can enforce the contract between the insurance company and the participating provider.

only to the extent of the medical provider attempting to make a claim directly from the patient that per the contract would be paid by the insurance provider. It does not allow them to force an insurance company to actually pay the hospital. It simply allows them to deny liability for such a claim. What the medical provider does after that is between the insurance provider and themselves.

 

[tranquility]

only to the extent of the medical provider attempting to make a claim directly from the patient that per the contract would be paid by the insurance provider. It does not allow them to force an insurance company to actually pay the hospital. It simply allows them to deny liability for such a claim. What the medical provider does after that is between the insurance provider and themselves.

I am uncertain as to your point. As an intended third party beneficiary, I can certainly demand the insurance company pays according to the contract they made with the provider. While the provider could sue on the breach, I could sue as well.

http://www.healthplanlaw.com/?p=604
http://www.law.uh.edu/healthlaw/perspectives/Privacy/010412Third.html (Discussing HIPAA not giving patients third party beneficiary status for contracts between a covered entity (like a hospital) and their "business associates" (like the hospital's lawyer) under FEDERAL law. Such rights are still had by state law.)
http://www.nsclc.org/wp-content/uploads/2011/09/Third-Party-Beneficiary-Claims.pdf