Am I responsible for a medical bill if the doctor’s office said I was approved by my insurance for treatment but I was not?

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Am I responsible for a medical bill if the doctor’s office said I was approved by my insurance for treatment but I was not?

Before starting treatment, I gave the doctor my 2 insurance cards. I was told that I was approved for 12 sessions, which I completed. Now my insurance company says they will not pay because they considered the treatment to be experimental. I would never had started treatment if I knew this was the case. Can I sue the doctor? I contacted the doctor’s insurance billing office and received no answer. I need surgery and may have to delay. I appealed to my insurer but doubt they will pay.

Asked on February 5, 2017 under Business Law, Illinois

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

Unfortunately, you most likely cannot successfully sue: the law puts the responsibility on you, the insured, to make sure that you are covered. You should have contacted your insurer to confirm coverage for this procedure. If you do not yourself make sure you are covered--and the *only* way to do that is to contact the insurer itself; the doctor's office does not and cannot speak for the insurer--you are responsible for the medical costs.


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