Is it legal for a health insurance company to charge more for a procedure than what the actual charge from the hospital is?

I recently had a procedure done. The actual cost from the hospital is around $2300 but the rate agreed upon between the hospital and insurance company is around $4800. Therefore the insurance company has paid the hospital around $2200 and I’m still responsible for the remaining amount. This doesn’t seem right.

Asked on July 25, 2012 under Insurance Law, New York


MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

I am not clear how that occurred but a) speak with the payment office of the hospital and b) file a complaint with your state department of insurance. Re-review your bill and the statement from the insurance company. It may be the total is the $4800 but the piece insurance agreed to pay is $2200.

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