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Contractual Law Question?
We live in Maryland, and in March of this year, I had to take my daughter to the emergency room. I dutifully paid my emergency room co-payment charge, and the doctor’s fees. I was told the rest would be handled by my insurance company (Blue Cross).
A few weeks later, I received a bill from the hospital stating that laboratory fees ($66.20) and emergency department fees ($169.70) came to a total of $235.90. My insurance company paid them $238. An overpayment of $2.10. Now they want an additional $164.10 from me. Various calls to their customer service department resulted in various answers ranging from “Oh, I think there is a mistake” to the latest “Our contract with your insurance allows us to demand this even though the procedure did not cost that much.” Of course, I have never seen the contract, and my demand to be given a copy was ignored
My contracts law class was a long time ago, but I do remember that not all clauses in contracts are necessarily enforceable. Advice? Thanks!
health care billing
Sounds like clerical incompetence. If you have a co-pay (rather than co-insurance or a deductible) then BC/BS has a contract with the hospital – you pay the co-pay, BC/BS pays the negotiated rate and it’s done. These type of HMO contracts specifically prohibit in-network medical providers from charging patients the “balance”. I’d call the hospital back and ask for someone in patient relations or go right to the president’s office
send a copy of the bill to your insurance company and forget about it.
Nope if you have the statement from Blue Cross showing that they were paid $238.00 then that is all that is due to them. If they have other charges you need to tell them to submit them to Blue Cross for payment if you have coverage, then if Blue Cross comes back and says they aren’t covering it then you can say the insurance company isn’t covering it and I don’t fully understand what the balance you are billing me is for to start with, so explain the bill, or send me an itemized billing for me to review with my attorney.