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legalgems, Lawyer
Category: Legal
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Experience:  Just Answer consultant at Self employed
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This in regards to my husbands health insurance. I called on

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Hi this in regards ***** ***** husbands health insurance. I called on his behalf the day before his surgery to confirm that his particular doctor was in network. I was told yes. They have notes on that call I asked about in network coverage. We received a bill that listed him as out of network
JA: What state are you in? And is a local attorney or other consumer protection advocate helping with this?
Customer: Wisconsin, not yet
JA: What steps have you taken so far?
Customer: I have talked to several supervisors. I was told that that if it is on the call the claim woukd be covered. I am waiting to hear recorded call.
JA: Anything else you want the lawyer to know before I connect you?
Customer: This is a 14k insurance claim. I have dates and reference numbers to calls. I have been told that all the calls are recorded.

Hello! I will be reviewing your question and posting a response momentarily; if you have any follow up questions please respond here. Thanks!

Customer: replied 6 months ago.

I am terribly sorry to hear this; especially when taking the time to confirm a provider was in network.

If a company/agent of that company misrepresents information and the customer reasonably relies on it to their detriment they may sue for damages (those that are "reasonably foreseeable and proximately caused) resulting from the negligent misrepresentation.

So for example if a provider is represented as in network but they are in fact out of network, the patient may sue for the difference.

Small claims is appropriate for cases less than $10,000 (i'm not sure what the difference between the in network and out of network cost is) otherwise general civil court would be required;

Further questions please post here.

If no further questions kindly rate positively so the site credits me for my time.

The above information is for educational purposes only; if one seeks legal advice please contact the local bar association for a referral to a licensed attorney in your area that is able to review your case in a private, confidential setting and will be able to tailor advise specific to your situation.

legalgems and 2 other Legal Specialists are ready to help you
Customer: replied 6 months ago.
I have been writing down dates of conversations and reference numbers.
Customer: replied 6 months ago.
The insurance claim is for 14k

The amount in dispute would be the difference between what the insurance pays for in network versus out of network; so for example if in network would have cost $5, 000, then the "damages" are $9,000 and small claims would be appropriate.

And keeping a journal is ideal-many people don't think of that.