What are my legal rights if a doctor in the ER did not state that his fee would not be covered by my insurance company?

Get Legal Help Today

 Secured with SHA-256 Encryption

What are my legal rights if a doctor in the ER did not state that his fee would not be covered by my insurance company?

About 9 months ago, I had to go to the ER for pain in my right torso. There was a set amount that I had to pay for any ER visit according to my insurance company. However, the doctor who saw me sent me his bill as well. He never told me that his services would have an extra fee and that it would not be covered by my plan. Now I am getting calls almost every day for the fullfillment of an almost $2000 fee for him basically just perscribing me pain medication. Also, I do not understand why I am being billed seperately by the physician when I didn’t go there to specifically see him. If he works for the hospital, shouldn’t he be paid by the hospital?

Asked on December 18, 2016 under Business Law, Texas

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

Unfortunately, it has become common for hospitals to subcontract their physician services out, so that the hospital and the doctor or his practice bill you separately. However, if your insurer covers all your ER costs (but for your copay), they should cover this: the fact that you were srnt 2 bills, not 1, does not make this not something covered as per the ER coverage of your policy. Submit the bill to yiur insurer; if they won't pay as per the policy, you could sue your insurer for breach of contract (since an insurance po k icy is a contract) and/or try filing a complaint with the state agency regulating insurance.


IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

Get Legal Help Today

Find the right lawyer for your legal issue.

 Secured with SHA-256 Encryption