Legal Question in Insurance Law in Virginia

Hospital bill not paid by insurance co.

The hospital that my husband was admitted to during an emergency failed to call the insurance company to get precertification for admission. Therefore, the insurance company penalized me 25% of the bill for their mistake. Am I legally responsible for this bill? I know I have to pay the doctors and any other bills associated with his stay since they did not have to contact the insurance company, but I was still penalized for their bills also. When I called the hospital they told me that they called the insurance company and was told they didn't need to precertify which is a lie to cover up their mistake. It clearly states on the back of the card that precertification is needed for admission. I feel they are responsible for these additional charges and should write them off. Do I have a leg to stand on. Since the stay, my husband has died and without life insurance.


Asked on 6/25/07, 10:34 am

2 Answers from Attorneys
Michael Hendrickson Law Office Michael E. Hendrickson

Re: Hospital bill not paid by insurance co.

Unfortunately, I suspect that this is a matter that will have to be settled between you and your insurance company rather than you and the hospital. (Knowing how insurance company as well as other bureaucracies operate, it's quite possible that in fact the hospital did call the insurance carrier for precertification approval and some insurance rep gave them the wrong information. This alleged call should be further investigated in more detail to determine who in fact may be responsible for the error.)

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Answered on 6/25/07, 5:02 pm
John Jackson Law Office of John A. Jackson, P.C.

Re: Hospital bill not paid by insurance co.

It is possible that you are not responsible but to make that determination an attorney would need to see your insurance policy, the correspondence that the insurance company sent you and the contract that the hospital has with the insurance company. I or any other attorney that post here would be happy to help you for a fee. Feel free to contact my office.

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Answered on 6/25/07, 1:33 pm


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