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Delta-Lawyer, Attorney
Category: Legal
Satisfied Customers: 3546
Experience:  10 years practicing IP law and general litigation
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My 21 year old daughter believing that she had Blue

Customer Question

My 21 year old daughter believing that she had Blue Cross/Blue Shield health insurance through her mothers work health plan agreed to have an elective surgery to repair some damage to her vocal chords that was sustained when she was a baby this past January of 2016. Come to find out a few weeks ago that her coverage had been terminated as of Dec 31, 2015. The surgery claim for $8,200 was rejected. My question is does the hospital bare any responsibility for not confirming her insurance status prior to having the surgery? Of course if my daughter was aware of this she probably would not have gone ahead with the surgery.
Submitted: 3 months ago.
Category: Legal
Expert:  Delta-Lawyer replied 3 months ago.

I hope this message finds you well, present circumstances excluded. I am a licensed attorney with over a dozen years of experience handling matters of this nature. It is a pleasure to assist you today.

The hospital should bear some responsibility here. The basis for this responsibility is that they are supposed to verify insurance coverage, based on their own policy, in most cases. This is particularly true when an elective surgery is scheduled. The reason is that insurance, even when active, often times will deny coverage on elective surgery. As such, the hospital normally checks extensively with the insurer to make sure coverage will be provided. They recognize that elective surgeries that are not covered frequently result in no payment.

So, the hospital does bear culpability here for not checking on the coverage. If the insurance company did not properly notify you guys of the cancellation before cancelling, they also bear culpability here as well relative to what is owed for the surgery. That is something that needs to be checked on as well...when did they send this notice and how did they send this notice before cancelling the policy.

Let me know if you have any other questions or comments. Please rate my answer positively (THREE OR MORE STARS) on the ratings bar on your end.

Thank you and best wishes!

Expert:  Delta-Lawyer replied 3 months ago.

Did you have any other questions or concerns? Thanks

Expert:  Delta-Lawyer replied 3 months ago.

Just checking to see if you have any other questions or concerns. I want to make sure you are as comfortable as possible as you move forward. Thanks

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