In September of 2011 I cut my hand and went to the emergency room because I thought I needed stitches. I had been to St. Rose in April of 2011 for a procedure and they accepted my bc/bs so I didn't even question coverage. They treated me without asking for my insurance info. After treatment as I was walking out the door, they stopped me & took my info. They came back and told me they were no longer in my network. Obviously if they had told me ahead of time I probably would have gone to another ER that took my bc/bs. Now I'm being billed for the balance that my insurance didn't cover. If they had been in my network, St. Rose would have accepted bc/bs as payment in full. And as of November 2011 they are back in network, so only out of network from July to November 2011. I disputed the bill explaining the situation but it was denied as not a good reason to waive the balance. Do I have any remedy other than paying the balance due? It's $562. Thanks, Debby
Country relating to Question: United States
State (if USA): Nevada
Disputing the bill by letter which was denied.
Welcome and thank you for your question!I am so very sorry to learn of your experience. Please clarify: when you were at the hospital, did you sign paperwork that said you agreed to be financially responsible for any charges in the event services are not covered by insurance?
Unfortunately I did only because I was taken by surprise and didn't know I could refuse to sign. I had never experienced this situation before & was totally shocked that they didn't accept bc/bs anymore and that I wasn't informed before being treated that I would be responsible for any balance due.
Thank you. Such paperwork is common/routine in all medical settings: doctor's offices, clinics, emergency rooms, hospitals, etc.The facts that you describe are most unfortunate, indeed.Keep in mind that the law does not require the hospital to determine, in advance, whether or not you have insurance coverage.And, there's no law which requires the hospital to inform you, in advance, that they do not accept your insurance.Why is this so important. Because the law does not create those responsibilities for the hospital, what's left is the written agreement to pay that you signed. That document becomes a contractual obligation between you and the hospital. Insurance now becomes irrelevant.The hospital is now in the position to send your file to collections and/or sue you for Breach of Contract.Separately, you can follow-up with your insurance company to see if they will provide out-of-network coverage for this matter. They may not if they decide that it wasn't a true emergency requiring an ER visit or if you have a super-high deductible for out-of-network matters. But, it's an option to explore if you have not already.What are your options now?If you wish to continue this conversation, click on the Continue Conversation link. If you are satisfied that I have answered your question, then please rate the answer with a four or a five so that I receive credit for assisting you. Positive ratings are the only way I receive credit for assisting you today.IF you feel the need to click either "Helped a little" or "I expected more," then do not rate me (not yet, anyway!). Instead, reply to me using the REPLY or CONTINUE CONVERSATION button. Specify what additional information you need and I will be happy to continue further and do everything I can to provide you with the service you seek. Thanks, ~~ J.B.
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