What to do if we were told that a hospital participated with our insurance but now it says that it doesn’t and it wantsthe us to pay full balance?

UPDATED: Aug 8, 2012

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What to do if we were told that a hospital participated with our insurance but now it says that it doesn’t and it wantsthe us to pay full balance?

My husband had a 15 minute outpatient procedure and they are charging over $30,000 for the hospital alone (we’ve paid the surgeon and anesthesiologist already). The price is exorbitant but they say we owe it and want to be paid. Our insurance only covered $1250. Is there anything that governs how much they can charge? The hospital was in our network and never told us they terminated their agreement, are they obligated to let you know when they don’t participate?

Asked on August 8, 2012 under Bankruptcy Law, New Jersey


FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

Given the dispute over whether there was insurance coverage for your husband's surgery with the health care provider and the hospital, you should consult with an attorney that practices in the area of insurance law to advise you on what your legal recourse is. If you went into the procedure thinking that insurance was going to cover the vast bulk of the expense based upon representations by the carrier, the carrier should step up to the plate and cover what it ordinarily would have covered.

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