Can I legally be charged the “uninsured” amount by a hospital even if the insurance company approved it and paid the negotiated insurance rate?

Due to numerous errors by our insurance company and my husband’s former employer, a hospital bill from 16 months ago is just being paid by the insurance company. Despite actively working with the insurer and the hospital to get this resolved, the bill for the full uninsured amount was turned over to a collection agency. Now insurance has approved it and is paying the amount the hospital originally invoiced the insurance company for. The debt collection agency is seeking the difference of the insured and uninsured amount from me. Can they legally do that being I was covered and insurance paid the claim?

Asked on September 21, 2011 under Insurance Law, Tennessee


M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

Trying to negotiate insurance coverage can be a full time job when there are mis-haps like this with bills, etc.  I can only give you some generalities here because there may be issues such as deductibles or co-pays that apply with the type of coverage that you have to it is difficult to really know what you owe from this end.  But if the hospital had a contract wit your insurance company to pay for the services rendered at a specific rate then it was agreed that they would accept that rate regardless of the "actual" charge for the services.  So the collection agency should not be coming after you unless it is as I said for a co-pay amount or a deductible not met. Contact the state attorney general's office and see if they can help.  It is not really an issue for your state department of insurance anymore.  Good luck.

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