United Healthcare Choice Plus is making us pay a 500 penalty because Saddleback Hospital did not get in-network pre-authorization

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United Healthcare Choice Plus is making us pay a 500 penalty because Saddleback Hospital did not get in-network pre-authorization

This was for a breast biopsy. Physician and Saddleback are in-network. We have a PPO. They received

Asked on June 25, 2018 under Insurance Law, California

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

The problem is, fair or not, medical bills are the *patient's* responsibility: the insurer essentially reimburses them or pays them for you, but is not principally liable on or for them. As a result, the onus or responsibility is on the patient to ensure that everything is covered, that everything is authorized in advance (if preauthorization is necessary), everyone is in-network, etc. If this is not done, it is the patient who is liable for any costs or for any penalties due under the terms of the insurance policy (which is, after all, a contract, and so something to whose terms you are held).


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