insurance company or hosiptal?

[spotntay]

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

My husband had a bad reaction with a cold medication. went to the ER on a Sunday.The company I work for was changing insurance providers and I had not received my new insurance card. I told the hospital what the situation was, gave them the old insurance card and told them who the new insurance was with. They said there would not be a problem that they had a contract with the insurance company just to bring the card in when I got it. The insurance paid for the ER care but not the test that they ran because they were suppose to notify the insurance company before the test. I now have a $16,000 hospital bill and am being sued. Is there any chance that I can only be liable for the amount that my insurance company would have paid? Is there anyway I can find out what that amount is?

Any information will be greatly appreciated.What is the name of your state (only U.S. law)?

 

[ecmst12]

If you are being sued, it sounds like you should have contacted your insurance company to appeal their decision a LONG time ago.

 

[spotntay]

I did contact my insurance company and they sent a letter to the hospital stating that The Hospital did not did not notify the health care providers before performing certain procedures or services as stated in the contract.
Therefore according to your network contract the member may not be charged for these services. This letters was sent twice to the hospital. The hospital then turned it over to a collection agengy. I faxed copies of both letters the the collection agengy. Now the collection agency is sueing my husband.

I was diagnosed with breast cancer shortly after this and the insurance company has been great so I really didn't want to make them mad.

So are you saying that there is no way to get the amount owed reduced to what the insurance company would have paid?

 

[justalayman]

Therefore according to your network contract the member may not be charged for these services

you need to be reporting this to the insurance company. As a PPO, the hospital is bound by the contract they sign with the insurance company and if the contract says they cannot bill, as you have posted, then the cannot bill and this issue is between the hospital and the insurance company.

the insurance company should be duking it out with the hospital.

 

[ecmst12]

If this hospital is contracted and is balance billing you outside the terms of their contract, they are committing FRAUD. Your insurance company will be VERY interested in putting a stop to this. You should have gotten them involved from the very beginning!