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Sam, Attorney at Law
Category: Legal
Satisfied Customers: 27011
Experience:  More than 20 years of experience practicing law.
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In mid-may I had an emergency room visit - my insurance has

Customer Question

In mid-may I had an emergency room visit - my insurance has already reimbursed the hospital for about $3,700 of the resulting bill, and I am being presented with a bill for the remaining amount, a little over $500.
However, the ER personnel did not actually resolve the problem for which I had come (the physician basically said it would be hard to do and sent me on my way), and I had to then seek medical help from a private professional in order to have the issue addressed, resulting in a delay of another 24 hours before the bleeding could be stopped. But equally if not more distressing to me, one of the ER doctors ordered tests on me which common sense suggests were irrelevant to the issue for which I'd sought help, and which are a severe embarrassment to me - especially knowing as I do* that these tests will remain on my medical records for the rest of my life. Oh, and not that it matters particularly to me, but I have still never received any results from these tests.
So my question is: do I have any recourse to fight back about these charges, being as they did NOT provide the service for which I had come to them, and they DID perform probably-unwarranted services (lab tests) which were not relevant to my symptoms and which were an embarrassment to me, and for which I have never even received the results (useless though they would be to me)?
I was frightened and in real need of timely medical assistance, and they were not only useless but also incredibly callous and seemingly lacking in compassion or regard for dignity. So the principle of the fight is as important to me as the expense.
Thank you for any advice or expert opinion you might offer,
* I am a software designer/developer whose expertise is to design and develop very large high security databases, which means I've designed the databases containing the health records for a majority of the patients in the United States. So I'm not just guessing or speculating here - I am speaking with authority when I say that even being subjected to such tests will remain in my medical history and be known by my all of my future medical caregivers.
Submitted: 1 year ago.
Category: Legal
Expert:  Sam replied 1 year ago.

Hello Pamela

This is Samuel. I am sorry to hear of this situation. I suggest you should first contact the hospital and tell them why you feel you should not be billed for the $500 and that they should be accepting the payment your insurance has agreed to. Consider tell them, that if they are reluctant to remove the $500 balance, you will make an insurance fraud complaint against them because you were not helped and feel being billed a balance after your insurance company paid, is unreasonable for their incompetence.

Expert:  Sam replied 1 year ago.

If you do not get the cooperation and satisfaction you deserve, then I suggest you move forward with filing a complaint with the Insurance company and the Insurance Commission. You can make a complaint about a provider (doctor, auto/windshield repair shop, etc.) exaggerating the severity of a condition in order to inflate an insurance claim with this contact information
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Expert:  Sam replied 1 year ago.

As a last resort, I suggest you can pay the balance and then bring the matter to small claims court, but suing a hospital is timely and can be consuming.