Filling Law Suit against Insurance Company?

Question

Hello,
I want gudiance about file law suit.I went to hospital last Nov-2006 for treatment my insurance campany suggest the location.Now more than 7 month the hospital send serval latters that pay your remaing amount and I call my insurance company they said they pay every thing and you don't pay panney.Now Hospital foward my name into collection agency and they send me notice for recovery.I;m in tennsion and worried suggest what will I do if this is case of law suit please suggest lawyer I'm living in Thousand Oaks CA

Answer 1

First of all, you need to find out if the insurance company paid their part (the contracted rate) because if they did, then filing a lawsuit against them is pointless. Call your insurance company again and this time ask them how much was paid, when it was paid, and how much the hospital was supposed to write off.

It almost sounds like the hospital is balance billing you. That means that the insurance company paid the contracted rate and the hospital is billing you for the rest (which they're not supposed to do if they are contracted). If you went to a contracted hospital, then the insurance only has to pay them the contracted rate and the hospital has to write off the rest of the bill. Then call the hospital's billing department with the information you got from the insurance company. They will probably want a copy of the Explanation of Benefits. If so, you will need to call the insurance company and have them send that to the hospital (or collections agency).

Another possibility is that the hospital is not satisfied with what the insurance company paid them, in which case they are supposed to dispute that with the insurance company, and not you. If that is the case, call your insurance company again and make them aware of this. They should be able to help you resolve this.

Answer 2

Lawyer or lawsuit may be an option, but only as a last resort.

First check
1) Did the insurance company pay the hospital?
a. If so, the hospital should not be billing you. Just have the insurance company send you proof that they paid the hospital and then you send copies to the hospital and the collection agency with a letter saying the bill has been made.
b. If not, ask why. Do they say that you were not insured, that this procedure is not covered, that the hospital charged too much, etc.? That affects what you need to do.

Answer 3

Verify with the insurance company what they paid and then verify that the hospital received that amount. Does your policy pay 100% or do you owe a co-pay? There can be errors by both the insurance company and the hospital in their payment and billing departments.
After you get this resolved, make sure that nothing bad is on your credit report from the hospital.

Answer 4

Guidance for a legal matter is going to come for a lawyer.

But I can tell you, your problem seems to be with the hospital, and not with the insurance company. Have you called the hospital billing department to figure out why they haven't credited the payment from the insurance company??

Answer 5

Before filing a lawsuit seek help from the CA Dept of insurance first. Normally, they will try to assist you in a dispute with your health insurance company. Check their website for more info before hiring an attorney that will cost you a small fortune.

http://www.insurance.ca.gov/

Good Luck

Answer 6

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