Does a doctor’s office have a legal obligation to notify the patient if the first insurance quote is a misquote and the procedure is not covered?

Asked on February 21, 2013 under Business Law, Indiana


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 7 years ago | Contributor

If it was not an emergency procedure and they became aware of the problem before the procedure was done, then yes--they should notify the patient. Otherwise, if the patient can establish that he or she only had the procedure done based in part on the doctor's claim that it would be covered, the patient may be able to hold the doctor liable for the cost (or at least for the additional cost over and above that portion or co-pay which the patient would have had to pay anyway).

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