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Q: Hospital Not Under Contract
asked by: millergold on March 1st, 2007
New User
Recently, I was seen by a hospital that was not under contract with my health insurance. I repeatedly asked the check in people and nurses about whether my insurance was ok and they kept telling me it was ok. I also asked whether or not I needed to contact my insurance company. They said they would take care of everything and that it should all be ok. With out getting into too much detail, I've had almost $10,000 worth of visits/procedures done by this hospital. (This is actual cost).

Now, my insurance is willing to pay for their portion of the costs but since they are not under contract with this hospital, the usual deferred part of the bill has been fitted to me.

Now, I do not know what to do. It seems pretty ridiculous for me to have to pay for the whole bill because someone at the hospital didn't check to see if my insurance was under contract. I could have easily gone down the street to a different hospital, which was under contract with my insurance and not had to have paid the deferred portion of the bill.

Any advice would be much appreciated. Thanks in advance.
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SunflowerRN
replied on March 14th, 2007
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Unfortunately, you as the member are partly responsible. Instead of checking with the hospital, who may not understand fully what type of plan you have and what it covers, you should've checked with the insurance company to be sure.
I work for an insurance company and too many times we receive calls from members wanting us to cover out of network services as in network either because they don't want to use our network or because they weren't aware dr/facility was out of network. Members need to take responsibility, not just hospitals or physicians.
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millergold
replied on March 20th, 2007
New User
I Understand
I appreciate your response. I am more than willing to take responsibility for not checking with my insurance company. It just frustrates me when I repeatedly asked the hospital if everything was ok and they said yes. I guess the moral of the story is that hospital secretaries are idiots and that you can't trust them.
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Sunflower_pie81
replied on March 20th, 2007
Extremely eHealthy
I work in insurance, and i see this happen to a lot of people; however being the subscriber to the insurance it's your responcibility to check to see what doctors/hospitals/facilities are in your network...there isn't much you can do from here. in the future you need to contact your group as they will have a list of facilities you are in your network. A lot of people don't understand this part of their insurance. i think that the nurses and the people that were checking on your insurance, may have thought that they accept your insurance but they are out of network. some facilities do not accept certain insurances at all and that is where the confusion comes in......

so study up on the facilities that are in your network.

good luck.
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