What to do if a hospital took my insurance card and told me that I was covered for a surgery that I then had, however my insurer later denied the claim because the hospital is not in-network?

There is no out-of-network coverage on my policy. I’m on a second level of appeal with the insurance company and need help. What do I do?

Asked on February 4, 2013 under Insurance Law, Utah


MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 7 years ago | Contributor

You need to sue both your insurance company and the hospital.  Further, though you are obligated to ensure that you are covered by the insurance company prior to surgery, if the hospital did its due diligence to get this information and relayed false information upon which you relied, it must eat the cost of this surgery.

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