Expert: Ontrack Financial Group llc - 6/5/2008

Question
QUESTION: I had Back surgery and the day before a went in and had a blood test in they made sure I had an insurance approval number. A year later A lien is on my house for 28,000 dollars. When I asked my insurance they said the hospital never sent them the bill. I have a letter from the insurance company for that surgery stating they would not pay it until they got more info from me. By the way I had seen every doctor to avoid surgery. The insurance company would always send the same letter that they needed more info before they would pay. I finally went to the insurance company with all these letters before my surgery took place and asked what do you need to know. They asked if I had any other insurance and if this was a Law suit case. I told them no and they said I would not have to come back if I got more of those letters. I don't have the money to get an attorney. Do you think I could get the ruling reversed since I have proof of approval code form the insurance company and a letter from the Insurance company saying the hospital never turned in the claim and then another letter from the same insurance company saying they need more info before they could pay it. PLEASE let me know something. Steve

ANSWER: Steve,

We're sorry to hear about this issue.  Was the insurance company ever billed by the hospital?  If not, who at the hospital was responsible for billing the company and receiving the approval code prior to the surgery?  Final question, do you still have insurance from the same company?

Ontrack Financial Group

---------- FOLLOW-UP ----------

QUESTION: The insurance said the hospital never billed them but, I got a letter from my insuranse saying they could not pay the bill until they got more info from me. I'm no longer w/ that insurance but I did keep paying them $610/mo.for cobra insurance in the case I would need another surgery. Please read my orginal question again. I think you missed some details. thanks, Steve

Answer
Steve,

When you were admitted into the hospital you signed what is called "Conditions of Admissions, this contract outlined the fact that your ultimately the responsible party as the beneficiary of the work performed.

If the hospital had the approval number prior to the surgery, the bill should have been submitted and paid.   

You may have recourse against the hospital for not submitting the claim properly and or against the insurance for giving an approval number but not paying the claim.  Check with your states tort laws.

  
Good Luck