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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 118286
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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A few years ago, our 7 year old son was diagnosed with PDD

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A few years ago, our 7 year old son was diagnosed with PDD NOS due to showing signs of delay in social development at 2.5 years of age. We obtained all kinds of services through the state and followed professional advice. A neurologist recommended having a genetic test done to see if either parent carried a gene to cause autism or something else contibuting to our son's delays. We had the test done - a blood test, one from each parent. I had insurance and expected it would be covered. I am now about to be sued/have my paycheck garnished for this test which ended up costing $10,000. This price/cost was never dscussed with me prior to the test. My insurance company denied the charge claiming my son had a pre-existing condition that was not reported to them. My employer went through a phase where they were changing insurance companies every year to avoid the increase in costs to employees each year and keep costs down. I think this had something to do with the denial. In any case, PDD NOS - 'Not Otherwise Specified' - NOS, is vague and we didn't really know what was going on at the time - following the advice of professionals everywhere... trying to find out if this was medical or what. We have no way to pay this $10,000 debt. What do we do? Can this organization/hospital rightfully sue us for the cost of that test which is $10,000? I've received notices from court threatening to have my pay garnished for it.
Thank you for your question. I look forward to working with you to provide you the information you are seeking.

Unfortunately, the hospital can sue the patient for the cost of the test, even if the cost was not explained in advance. When a patient has insurance, the patient is still liable for payment in the event the insurance does not pay. Thus, your claim is for breach of contract against your insurer at the time to force them to pay and that their claim that this was pre-existing and not reported to them is merely a pretext to breach the contract in bad faith.

Also, you need to contact the hospital and be persistent and go through the supervisors and negotiate the amount of the bill and even a payment plan as most all hospitals, despite what they tell people to get them to go away, will ultimately end up discounting bills 50%-75% when patients complain and are persistent in arguing their case through the billing supervisors up the chain in the hospital.

These are your two options legally since otherwise the hospital can sue you for the matter and if the hospital got a judgment they can garnish your wages for the debt for which you are ultimately liable if your insurance did not pay.

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