What to do if I had a routine colonoscopy and my doctor’s office sent me to facility not contracted with my health insurer?

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What to do if I had a routine colonoscopy and my doctor’s office sent me to facility not contracted with my health insurer?

They have submitted a claim for $19,137. My insurer denied paying the facility, since my benefits do not include colonoscopy if done out of network. I appealed multiple times but they refused to pay. The facility didn’t send another bill to me but instead they send it to collectors $5,890.41 ($5,000 bill +$865 interest). Does the facility have a right to send me to collection without sending me the itemized bill? Do they have a right to include interest? Can I sue them?

Asked on September 29, 2012 under Bankruptcy Law, California

Answers:

FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

Whether or not your treating physician's office was negligent in sending you to an out of network facility where the procedure that you underwent was not covered by your health care insurance depends if a member of your treating physician's office knew that it was very important that you have the procedure done in network before the procedure was done.

Another factor is whether or not there was some other nearby facility that could have done the procedure that you underwent that was in network.

I suggest that you speak with your treating physician about the current situation and the best way to try and resolve.

The facility that you seemingly owe money to wase entitled to send your bill to collections without sending you an itemized bill. Accrued finance charges (not interest) is allowed.

You can file suit against the provider which is your right in this country but from what you have written, I do not see a basis for you to do such against anyone other than perhaps your primary physician's office. I suggest that you consult with an attorney who practices in the area of medical law and health care law for further assistance in the matter that you have written about.


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