What are my legal rights if a doctor in the ER did not state that his fee would not be covered by my insurance company?
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What are my legal rights if a doctor in the ER did not state that his fee would not be covered by my insurance company?
About 9 months ago, I had to go to the ER for pain in my right torso. There was a set amount that I had to pay for any ER visit according to my insurance company. However, the doctor who saw me sent me his bill as well. He never told me that his services would have an extra fee and that it would not be covered by my plan. Now I am getting calls almost every day for the fullfillment of an almost $2000 fee for him basically just perscribing me pain medication. Also, I do not understand why I am being billed seperately by the physician when I didn’t go there to specifically see him. If he works for the hospital, shouldn’t he be paid by the hospital?
Asked on December 18, 2016 under Business Law, Texas
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 7 years ago | Contributor
Unfortunately, it has become common for hospitals to subcontract their physician services out, so that the hospital and the doctor or his practice bill you separately. However, if your insurer covers all your ER costs (but for your copay), they should cover this: the fact that you were srnt 2 bills, not 1, does not make this not something covered as per the ER coverage of your policy. Submit the bill to yiur insurer; if they won't pay as per the policy, you could sue your insurer for breach of contract (since an insurance po k icy is a contract) and/or try filing a complaint with the state agency regulating insurance.
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