Question:
Has anyone had an in-network hospital sue after insurance paid?
My in-network hosipital is dissatisfied what UHC paid them by their network contract, and now they are suing me for the difference. Any help would be appreciated. — skip T. (posted on January 31, 2005)
January 31, 2005
I would call UHC, and tell them this. Did you get your EOB in the mail yet
for what the insurance co paid the hospital, and what your are resposnible
for? It may be your deduction or out of pocket expence. If the insurance
co says they should consider it payment infull, the insurance co will go
after the hospital and they cant charge you. BUt call UHC and see what
they say, it may be your responsibility. If so try to work out a payment
plan. Good luck Rosemary
— wizz40
January 31, 2005
My hospital and doctor we out of network and I understood from the
beginning that they would only pay 70%. However, after the surgery was
done, UHC paid the bill, then a few days later, changed their mind, and
said it was an error, and they didn't consider my surgical institution was
a hospital and asked said hospital for its money back!! Denied to pay the
whole thing! About $58K ! I sent a registered letter of appeal to my HR
and UHC, explained that permission was given for the surgery, plus
pre-certification was given to my surgeon and my "hospital" by
UHC before it was ever done! How can they decide after the fact that
everything wasn't OK? I cited my own employer's Summary Plan Description
back to them, also citing that , at the minimum, the "usual and
customary charges" should be paid. I guess my letter was good enough
, because they paid TOTALLY in full for the whole thing, even though it was
out of network. Go figure that one out!
In your case, I always understood that if the hospital is IN Network, that
means they have contractually agreed to accept what the insurance company
pays, and the bills even state "you are not responsible for the
difference." By agreeing to the contract with UHC as a network
provider, they must accept what is paid by UHC.
At least ,that's the way I understand it to work.
— Anna S.
January 31, 2005
i have UHC also. If they are contracted with a doctor or hospital they
CANNOT go after you. It is illegial.
— Delores S.
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