• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Med Bill Dispute - Provider mistake

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

Mike_MedBill

Junior Member
Hello

Recently I got an endoscopy and colonoscopy done at a center in Southern California. The provide had contacted my insurance before the procedure and determined my part of the charges. A billing agent from the provider called me and said I have to pay $285 my part of the charges upfront and that’s it. On the day of the procedure I paid that amount and asked them if I would be getting any other bills, they said no. But couple of days later, I got a bill from the center in the amount of $1140 (total of $1425). I called the center and asked them why have they billed me more when I was told I just have to pay $285. They said because I have a high deductible, I have to pay the whole amount myself. I told them they could have told me that before the procedure, so that I could have got it done at a much cheaper center. They did a mistake on estimating my part of the charges and I bear the brunt.

My question to you guys is, can I dispute this in a small claims court as it was a mistake on their part for not letting me know the exact amount. They told me a different amount (much smaller amount) which was affordable and hence I got it done. If they had told me the right amount, I would have looked for other cheaper provider. Is it worth disputing this in small claims court?
I appreciate any suggestions.
Thank you
Mike
 
Last edited:


Zigner

Senior Member, Non-Attorney
Hello

Recently I got an endoscopy and colonoscopy done at a center in Southern California. The provide had contacted my insurance before the procedure and determined my part of the charges. A billing agent from the provider called me and said I have to pay $285 my part of the charges upfront and that’s it. On the day of the procedure I paid that amount and asked them if I would be getting any other bills, they said no. But couple of days later, I got a bill from the center in the amount of $1140 (total of $1425). I called the center and asked them why have they billed me more when I was told I just have to pay $285. They said because I have a high deductible, I have to pay the whole amount myself. I told them they could have told me that before the procedure, so that I could have got it done at a much cheaper center. They did a mistake on estimating my part of the charges and I bear the brunt.

My question to you guys is, can I dispute this in a small claims court as it was a mistake on their part for not letting me know the exact amount. They told me a different amount (much smaller amount) which was affordable and hence I got it done. If they had told me the right amount, I would have looked for other cheaper provider. Is it worth disputing this in small claims court?
I appreciate any suggestions.
Thank you
Mike
You have no case - the provider isn't aware of your deductible status.
 

cbg

I'm a Northern Girl
Unless your insurance policy expressly and in so many words says otherwise, it was your responsibility and not that of the provider to investigate what the charges are. Your further mistake was in assuming that there would be only one bill.

The whole point of a high deductible plan is that your premium costs are low in exchange for your being responsible for a higher proportion of the medical charges.
 

ajkroy

Member
The good news is that potentially a large portion of your deductible is paid relatively early in the year. You can have other procedures this year without repaying the same deductible.
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top