If the hospital where I had a procedure done wants to charge an additional fee, must my insurer pay it?

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If the hospital where I had a procedure done wants to charge an additional fee, must my insurer pay it?

I had a procedure done and my deductible was paid. The hospital was under contract with the insurance company for a set amount for this procedure and it was paid. Now the hospital wants to charge another 1,000 for something extra that was done. The insurance company refuses to pay this charge. Am I responsible for this charge?

Asked on July 20, 2011 Wisconsin

Answers:

FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

You need to read your medical insurance policy with your health care provider to see what its obligations are with respect to payment for health related procedures. The insurance policy that you have will set forth what your carrier's obligations are as to you.

You also need to see what written agreements there were between you health care provider and your insurance company regarding payment for specified procedures. Some hospitals are unbder contract with certain insurance carriers where the insurance carrier specifically sets a set fee for the procedure and the hospital accepts payment for the set fee even if the actual cost esceeds the amount paid.

In such a situation, most likely the patient would not be required to pay any excess above the agreed upon fee.

Good luck.


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