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Dwayne B.
Dwayne B., Attorney
Category: Legal
Satisfied Customers: 32369
Experience:  Began practicing law in 1992
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I was told by a cancer treatment center that my husband did

Customer Question

I was told by a cancer treatment center that my husband did not require insurance authorization for a procedure called a lumbar puncture as long as the procedure was done as an outpatient .however my insurance company denied the claim because there was a clause that stated if it was done at a facility whitin 25miles of an approved facility they would deny payment.the hospital didn't even provide the correct testing results asked by the cancer center.the test was done for nothing.The hospital now wants to charge 5500.00 for the test.do i have any legal rights to refuse payment?
Submitted: 1 year ago.
Category: Legal
Expert:  Dwayne B. replied 1 year ago.

Hello and thank you for contacting us. This is Dwayne B. and I’m an expert here and looking forward to assisting you today. If at any point any of my answers aren’t clear please don’t hesitate to ask for clarification. Also, I can only answer the questions you specifically ask and based on the facts that you give so please be sure that you ask the questions you want to ask and provide all necessary facts.

No, you have no legal right to "refuse payment". You can sue and claim that they breached their contract by failing to verify insurance, etc. but you can't just refuse to pay since that can lead to charges for theft of services.

Also, usually at a medical care facility they have you sign papers stating that regardless of what the insurance company does you will pay the bill and that they aren't guaranteeing the insurance company will pay. If you signed that document it will be harder to win your case, of course.

You probably want to use a lawyer for this because they will certainly hire one and if they do have that paper then it is going to be an argument on contract interpretation and oral amendments, etc. which will require some legal knowledge and expertise. You can sue for your attorney's fees though.