Expert: John Hall - 6/19/2006

Question
Last month I had surgery on my hand for carpel tunnel syndrome.  Before seeing the doctor who would perform the surgery, I told my family doctor that they had to find a doctor who would accept my insurance.  They set up the appointment and I began seeing him.  It was determined that I would have tests and then surgery to fix this problem.  The doctor told me that I had two places I could have the surgery performed; the hospital and a surgical center that he had a financial stake in.  I told him that we could go ahead and do it at his center, as long as my insurance covered it.  Two days before my surgery, a lady from the center told me that I should come prepared with a $500.00 deductable for the surgery.  I told her that I should only have a $100.00 co-pay for the surgery and if that wasn't the case we needed to cancel the surgery.  She called 15 minutes later and told me that she had made a mistake and that I was only going to be responsible for a $100.00 co-pay.  On the day of surgery, I filled out my paperwork and paid my $100.00 with the lady telling me that I was paid in full.  That was just over a month ago.  We just got a statement in from the insurance company telling us that my doctor AND the surgical facility is NOT covered by our insurance.  My husband called and they told him that the surgical center AND the doctor's office called them, but only asked if we were insured.  No pre-authorization was asked for, nor was given by our insurance company.  The doctor's office is now claiming that we are responsible for this apx $10,000.00 payment.  I made my $100.00 co-pay for the surgery and was told all along that I was covered.  What can we do?  Are we going to have to seek out an atty.?  How can they tell us that I'm covered, only to turn it around and tell me that we're not?  I don't have this kind of money, nor do I feel that we should have to pay it even if we did have the money.  Thank you for your input.

Answer
Under the circumstances you describe, there are at least two wsays that you can avoid this disputed debt - but I can't say for sure without knowing more facts that you don't state in your questioon.   This will be easier to talk about on the telephone and I can then explain your options in more detail.  Call me back on my cell if you like.  I will not charge you just to talk on the phone.  661  492-2673