Legal Question in Insurance Law in Pennsylvania

Health Insurance claim messed up, Who's responsible?

My wife had an operation a few months back. Under our insurance plan we got the proper referral first for this operation from our primary care provider.

After recieving the first few insurance statements we noticed that their was patient responsibility on the bill,

For non-referral.

At that time we contacted the insurance company and they admitted they mad a mistake and would resubmit the claim. (the referral was attached to their paperwork.)

Since then we have recieved several statements from the hospital for non-payment, each time contacting the isurance company to let them know. They apologize and explain how they are backed up.

Now we are recieving phone calls from a collection agency in which the hospital turned the bill into.

We try to explain to them that the insurance company screwed up and that all expenses were to be covered.

The collection agency has called us three times, (1 week span)(demanding payment or they will have this put on our credit report.Are they allowed to do this? and if not how do we get them to leave us alone?

Thank you.


Asked on 4/09/03, 5:20 pm

1 Answer from Attorneys
Andrew Solomon Law Office of Andrew A. Solomon

Re: Health Insurance claim messed up, Who's responsible?

Pennsylvania has a bad faith statute, that requires your insurance company to comply with its policy. If they fail to remedy the problem, you should consult an attorney to determine if a bad faith lawsuit is warranted. Under this law, if successful, you can recover punitive damages and attorneys fees.

Also if it is an HMO, they probably have a dispute procedure that you must follow--check your policy

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Answered on 4/10/03, 10:20 pm


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