Legal Question in Insurance Law in Texas

I have a Humana Medicare Advantage PPO. I went to the ER one night. A month later I get my EOB from Humana and they say my responsibility is $0.00. Humana made their payment to the ER. Medicare denied a couple of charges however, Humana states on my EOB that I am not responsible for the denied charges because I used a "Network Provider". Now I get a bill from the ER that I owe the denied charges. I understand that if the ER accepts my insurance and they are a network provider they cannot bill me for anything that my Insurance says I am not responsible for...correct?


Asked on 8/12/15, 7:05 pm

1 Answer from Attorneys
Robert Stephens Stephens & Stephens

You must write a letter to your provider and to the emergency room and tell them what you have just stated. If they insist on it, there should be an appeal provision in your Policy to require them to pay it.

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Answered on 8/17/15, 12:15 pm


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