Legal Question in Insurance Law in Pennsylvania

Insurance claim voided by the hospital after the insurance company paid

I had elective surgery in St. Vincent's Hospital in Erie, PA that was covered by my insurance. After the insurance paid, the hospital refunded the money to the insurance company and voided the claim, told the insurance company not to pay it. Now they are billing my for over $16,000 for something that should have been covered, except for my copay. Can they do this and what are my options? They accepted my insurance for the preadmission, why should they be able to choose what they want covered? I have all the statements from the hospital and from my insurance company, both, showing insurance paid according to thier agreements. The Hospital decided this was not enough. Can they do this and what can I do?


Asked on 11/05/07, 9:17 pm

2 Answers from Attorneys
John Jackson Law Office of John A. Jackson, P.C.

Re: Insurance claim voided by the hospital after the insurance company paid

This sounds odd. Call or email my office and we can discuss.

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Answered on 11/05/07, 10:22 pm
Roger Traversa Arjont Group (Law Office of Roger Traversa)

Re: Insurance claim voided by the hospital after the insurance company paid

You asked about a hospital that has reneged on an agreement to accept insurance coverage.

You have a case that I don't believe has been tested yet. In theory I agree with you and believe you should prevail on a theory of detrimental reliance. Would you have had the surgery at that hospital if they hadn't agreed to accept the insurance payment? Maybe not, but if you knew ahead of time you would have had the option to choose whether to have the procedure at that hospital or another that offered a better price.

You definitely need to speak to an attorney and should consider suing on this matter. Start by looking for an attorney with experience in medical insurance litigation.

Regards

Roger

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Answered on 11/05/07, 10:57 pm


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