What to do if a doctor's office failed to do due dilligence in verifying insurance coverage?
Question Details: With the 1st, 2nd, and 4th eye surgeries, the doctor's office managed all the insurance paperwork and verification of benefits. All were 100% covered. The 3rd surgery took place at a different location due to a secheduling issue; the business office failed to contact the insurance company to check the change of location. Scheduling was contingent upon insurance approval, and we confirmed twice with doctor's office that it was OK. Insurance has since denied the $18,000 hospital claim (no prior approval/out of network). The doctor's office has admitted fault and waived $9,000. Who is responsible?
Whenever you seek medical attention from a hospital there is always a battery of paperwork which you must sign. Included within all of the paperwork is an agreement that you will be the primary party responsible for payment of the hospital bill. When a person signs such an agreement it is not contingent upon what someone else may do to see to it that the bill is paid. Accordingly, under the fact situation given, you would be the person responsible for payment of the hospital bill. With respect to the lack of due diligence in verifying the insurance coverage, the task of verifying the coverage is a contractual one between you and the insurance company. Even though the doctor’s office may do the same AS A COURTESY for their patients the ultimate responsibility is upon the policy holder and not the treatment provider.
