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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Business Law
Satisfied Customers: 110401
Experience:  All corporate law, including non-profits and charitable fraternal organizations.
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I got slammed with a $4,700 bill for an MRI ordered by my urologist.

Resolved Question:

I got slammed with a $4,700 bill for an MRI ordered by my urologist. My health insurance only wants to pay $300 of it, even though I went through the whole involved pre-approval/authorization process, received a confirmation number, and everything (by the away, I was never told during the preapproval process that I would have to pay anything). I think that any person going through this process of calling toll free numbers, describing the study, and receiveing the confirmation number would consider that this means that the study will be paid for. Then, after I did the MRI I RECEIVE A $4,700 bill for which the insurance company only paid $300, saying that that is all that is left of my diagnostic studies benefit. I would never have considered taking the test had I known it would cost me $4000+. My initial appeal to the insurance company for them to pay more of the cost was rejected. What are my options for further appeal as I was utterly mislead that this study was being covered?
Submitted: 6 years ago.
Category: Business Law
Expert:  Law Educator, Esq. replied 6 years ago.
You would have to file a second written appeal with the medical records from the doctor documenting the necessity of the test. Then that appeal is rejected, your final option is to go to court against the insurer for breach of contract. IF the MRI provider was on the approved provider list for the insurer, then you can also argue for a reduction of the cost if they are charging you more than the insurer's reasonable and customary fees. Unfortunately, ultimately if the insurer is not found liable for the bill, it will be your liability and another option aside from going to court would be to call and negotiate with the MRI company, and in most instances they will begin by telling you they do not adjust charges and then if you are persistent and plead that it will create a financial hardship many times I have had them reduce bills by greater than 50%, but it takes patience and persistence and working your way through supervisors.

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