Legal Question in Health Care Law in Illinois

I have a surgery scheduled for 3/5/13 that my surgeon as agreed to preform and my pre-op tests are completed. But the hospital is refusing to do the surgery because my insurance will only pay a portion. Can they do that? what rights do I have?


Asked on 3/01/13, 8:07 pm

1 Answer from Attorneys

Without knowing more about the hospital and the kind of procedure it is really impossible to say. You should certainly start with your health insurance and find out what the issue is with coverage, and there may have been a glitch (such as the way the doctor coded the procedure for coverage purposes) along the way that somehow suggested the procedure is only partially covered when it should be more fully covered (subject to whatever deductibles are part of your plan). The hospital may also have incorrect information. Some hospitals must treat certain "emergency" cases but not every hospital is required to do so. Elective procedures are often not covered in whole or in part. Beyond that would be sheer speculation.

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Answered on 3/20/13, 12:54 pm


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