Legal Question in Health Care Law in Texas

Double Billing

My son sustained an injury on Dec 28 2001, took him to Emergency Room to be seen and treated. At that time my company had Pacificare health insurance. After varifing health care we were seen and released. My health provider at that time(Pacificare) paid for all the services minus my $50.00 ER co-pay. I paid that as soon as I was billed. Since then I have been getting an additional bill by the company that provides the X-rays at the hospital for an additional $200.00 dollars because they say they do not have an agreement with Pacificare for providing X-rays therefore I am liable for the entire bill (less what Pacificare already paid). How can that be, shouldn't the hospitial of told me before seeing my son that the x-rays were not covered by pacificare? What can I do to not have to pay the additional amount. Is there anyway I can get a class action suit against this company, I think they are ripping people off.


Asked on 8/26/02, 11:05 am

1 Answer from Attorneys
Michael Bynane Law Offices of Michael C. Bynane

Re: Double Billing

It sounds like your health insurance is based on a PPO arrangement and that the hospital was a preferred provider. If so, by law in Texas, the provider agreement between your health carrier and the hospital must cap your personal liability for hospital charges at the agreed discounted rate. Practice groups associated with the hospital are subject to agreements of their own that typically spell out their obligation to be bound by preferred provider contracts between the hospital and health carriers. You should be aware, however, that a definitive answer to your specific situation would depend upon a careful review of your policy and related circumstances.

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Answered on 8/26/02, 1:51 pm


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