Is this legal or a company to do?

Was at the doctor’s office for an appointment
for my son and the doctor’s office wasn’t sure
if he was covered yet because we were waiting
on his insurance to be approved. We called the
insurance company while at the doctor’s office
and they said he was covered and we would
receive no extra charges if the doctor saw him
that day so we went ahead with the appointment
the insurance company even talked to the
doctor’s office directly. Now we are being told
by our insurance company that he was not
covered that day and that his coverage didn’t
start until the following month and that if we
want that appointment paid for we either have
to pay them 200 for that month or pay the PCP
the 700 for the appointment. Point is we were
lied to and they are refusing to cover the 700
unless we pay them 200 for that month when we
would have just waited till the following month
if they had told us that he was not covered is
this fraud or is this illegal?

Asked on November 12, 2018 under Insurance Law, Pennsylvania

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 2 years ago | Contributor

Because their misinformation (their negligence or carelessness) caused you to incur costs you should not have, you could sue to recover that cost. However, as a practical matter, it may be better to pay the $200 for the coverage than to pay the $700 to the PCP and have to spend the time, effort, and cost of suing to get the money back, especially since even small claims lawsuits typically take several months from filng to actually getting the money in hand, which means you'd be footing or floating that $700 for a few months before getting it back.


IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.