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Tina, Lawyer
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i was brought to a new jersey hospital by ambulance for a

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i was brought to a new jersey hospital by ambulance for a heart attack. and had a medical procedure. the anesthesiologist is billing me for the balance after receiving payment from my insurance comp. is this legal?
Submitted: 4 years ago.
Category: Legal
Expert:  Tina replied 4 years ago.

I am an attorney and will strive to provide you with legal information to assist you but cannot give you legal advice, represent you, or enter into an attorney-client relationship through this open forum. Do you accept these provisions as well as Justanswer.com's disclaimer?

Please respond with a Yes or No to continue. Thank you.

Customer: replied 4 years ago.

yes

 

Expert:  Tina replied 4 years ago.
Thank you.

Many insurance companies will pay only a minimum fee charged by physicians and the balance must be paid by the insured.

This often occurs if you have an HMO and the physician is not an in-network provider and therefore does not have a contract with the HMO to accept whatever their policy is willing to pay.

It is a matter of contract law and will ultimately depend on what your policy covers and whether the physician had contracted to accept the policy limit and not hold you liable for any balance.

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Tina

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Customer: replied 4 years ago.

maybe i wasn't clear. the insurance company paid the anesth group about two thirds of their $1,800 charge. since i was brought into the ER by ambulance(heart attack) and could not negotiate a fee with the anesth i believe i should not be responsible for the remaining third of their charge. what do you think?

thanks

gary

Expert:  Tina replied 4 years ago.
I understand that the insurer paid less than what was billed. You are ultimately responsible for the charges, whether you have insurance or not though. The only question then is whether the physician should have accepted what the insurer paid or whether the insurer should have paid more than what they did according to the policy.
Tina, Lawyer
Category: Legal
Satisfied Customers: 32721
Experience: JD, BBA Over 25 years legal and business experience.
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Tina
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