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Legalease, Lawyer
Category: Legal
Satisfied Customers: 16379
Experience:  15 years exp all aspects of general law
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Can a horizon participating hospital demand payment prior to

Customer Question

can a horizon participating hospital demand payment for surgery prior to the procedure of a horizon member?
Submitted: 1 year ago.
Category: Legal
Expert:  Legalease replied 1 year ago.
Hello there ---If there is health insurance involved but the health insurance does not cover the entire balance of the surgical procedure, then any hospital or participating doctor can demand payment for any surgical procedure before the surgery date. I have actually heard of this happening frequently lately because many of the new insurance plans are not covering the entire balances of the procedures and if the facility believes that you can afford to pay the additional amount ahead of time, they can ask for it and even make it a policy not to perform the procedure until all or most of the balance is paid. -Please let me know if you have any further questions. If not, can you please press a positive rating above (third, fourth or fifth star in the ratings section above) so that I will be given credit for my time assisting you. The only way I receive credit is if you press a positive rating above. Your question will not close. THANK YOU MARY
Customer: replied 1 year ago.
Thanks for your reply.
I have worked in the medical field for forty years doing billing, pre-auths, etc. I have always understood that if a hospital/doctor participates with your insurance, they are obliged to bill the insurance and then bill the patient for any remaining balance that may be their responsibility. This is a contractual agreement on the hospital/doctor's part. Has that changed?
Expert:  Legalease replied 1 year ago.
Hello again ---Contractually, it may have changed in recent years to permit this to happen (that I am not certain of). However, legally speaking the hospital or doctors office does have the right to do it. If there is a contract in place with the insurance provider and the hospital that states that the hospital cannot do this , then they would be in breach of contract and it would have to be a private lawsuit against the insurer or hospital for doing this against the terms of the contract. My suggestion here is that you contact your state's division of insurance and ask them if there is any way that you can determine what the contract is and why they can get away with this and they may be able to give you some answers. HOwever, as I said, I have been seeing this more and more lately (my own family member had to pull out a credit card the other day to pay before a testing procedure -- I told them they could have at least waited until the day of the procedure). -MARY