Legal Question in Insurance Law in Texas

Doctor's Failure to Complete a Medical Referral

I recently was admitted to a hospital through the emergency room. A preauthorization for ''in-network'' rates through the insurance company, BCBS, is required. My dr. failed to obtain this referral and I am currently being billed at the ''out-of-network'' rate.

I suffered a ruptured brain aneruysm and was not able to oversee all of the details. I did call the dr.'s. office and was told to go to the emergency room when the event occured. I did all that was required by me as required by my insurance company.

Does a dr. have any liability in regard to the additional money I am being billed due to his lack of obtaining the preauthorization?


Asked on 7/19/04, 10:58 am

1 Answer from Attorneys
William Featherston Grissom, Richards & Featherston

Re: Doctor's Failure to Complete a Medical Referral

i do not believe that the doctor would have any liability in this regard. my experience tells me, however, that you should try to communicate with the hospital business office and let them know the problem and see if they can correct this problem with bcbs. if not, i would contact bcbs and see if they have a procedure to deal with this after the fact. good luck

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Answered on 7/19/04, 12:35 pm


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