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socrateaser, Lawyer
Category: Consumer Protection Law
Satisfied Customers: 39043
Experience:  Retired (mostly)
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I went in to a hospital to get an MRI. Before agreeing to go

Customer Question

I went in to a hospital to get an MRI. Before agreeing to go forward I asked the hospital admin if the test was going to be covered by insurance in full and if would not have to pay anything or what I would have to pay. She called someone and said no it will be fully covered. I did the test then weeks later I received a 2000 bill. I was lied to and now stuck with bill they are harassing me to pay. Do I have any options?
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  socrateaser replied 1 year ago.



1. Typically, you must receive an explanation of benefits from your insurer after any covered procedure. If the amount covered is insufficient, then you are entitled to appeal the insurer's decision.

2. If you are covered by a managed care plan (e.g., HMO), then billing any amount in excess of your insurance is an illegal "balance billing" under Connecticut law, and you can simply refuse to pay the bill on those grounds.

3. If you can prove that you were misinformed by the hospital staff, then that misrepresentation entitles you to sue for damages or defend in court on grounds of the misrepresentation.

4. If you don't pay, and the bill is sent to a debt collector, you can negotiate for a much lower settlement of the debt, because debt collectors pay only about 5%-10% of the face value of the debt. You can also offer a settlement amount to the hospital. Frequently, they will accept a lesser payment, because insurance would usually cover a much smaller amount than your bill.

5. You can file for bankruptcy protection and completely avoid the debt. This is, admittedly, a drastic option, but I'm including it to be thorough. Sometimes, when medical bills become overwhelming, bankruptcy is the only practical option.

I hope I've answered your question. Please let me know if you require further clarification. And, please provide a positive feedback rating for my answer -- otherwise, I receive nothing for my efforts in your behalf.

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Expert:  socrateaser replied 1 year ago.

Hello again,

I see that you have reviewed my answer, but that you have not provided a rating. Do you need any further clarification concerning my answer, or is everything satisfactory?

If you need further clarification, concerning this matter, please feel free to ask. If not, I would greatly appreciate a positive feedback rating for my answer -- otherwise I receive nothing for my efforts in your behalf.

Thanks again for using Justanswer!