can hospital bill patient directly without going through insurance?

Question

The hospital wants to bill me directly without submitting the claims to the insurance company. The reason is that according to the contract between the hospital and the insurance company, this charge is incidental fee and should not be charged to the patient. But the hospital wants to collect the fee directly from the patient without following its contract between the insurance company.

How should I deal with this situation?

Answer 1

Do not pay this charge! Trying to recoup an overpayment from a hospital is almost as fun as trying to get a refund from the government!

I am in agreement with the other posters here who state that IF there is a CONTRACT between the insurance company and the hospital, the hospital is REQUIRED to bill them directly, not bill you.

Charges listed as 'incidental' are again not allowed to be billed to the patient per contract. I would first talk to the hospital. Let them know that you understand the process and that you are not responsible for this charge. Also let them know that you will be notifying your insurance company and the State Insurance Commissioner. Who knows how many people they have tried to bully into paying costs that they are not responsible for.

I do this on a daily basis, fight overcharges for patients, and am amazed at the lengths that some facilities will go. I try to chalk it up to undereducated employees, but after doing this full time as my own business for over a year I'm not so naive.

Good luck and don't stop fighting!

Answer 2

If, as you say, the hospital has a contract with your insurance company stating that the charge is incidental *and* that the charge should not be billed to the patient, then the hospital cannot bill you for it. They need to follow their contract with your insurance company. Call your insurance company and explain what the hospital is trying to do - customer service should be able to pass on info to the contracting department, letting them know that the hospital is trying to circumvent their contractual obligation.

(Of course, this would not apply if the hospital were not contracted with your insurer and/or if their contract states that it is a charge that can be passed on to the patient.)

Answer 3

Yes. The hospital has NO OBLIGATION to bill your insurance company - most do it as a courtesy. Technically, it's YOUR responsibility to submit all insurance claims to the insurance company.

Once the hospital gets the agreed amount according to the contract (if they're in network), they should be reimbursing YOU the difference between what you paid,and the contracted amount.

Answer 4

If they have a contract with the insurance, part of the contract is that they bill for claims and take the payment. If there is no contract for your plan, then they can bill you.

Your best bet - call your plan and find out if the hospital is contracted. If they are, they're supposed to bill the plan.

Answer 5

Ron Paul has the facts wrong. Here is the quote from Nixon who signed the law. "Under S. 14, the Government would provide financial assistance to help various groups determine the feasibility of developing an HMO in their area, as well as assistance for planning and initial development. HMO's would be required to operate competitively without Federal subsidies at the end of an initial period of Federal support." The act was meant to help HMO grow, not force people to sign up for HMO. That come in 1990s when health care costs begin spiral out of control and many signed up without government involvement. HMOs stopped the spiral for a short time. If there was no government health care like Medicare and a ban on trial lawyers, we would have more uninsured and those who pay would pay more.

Answer 6

Call both the hospital and your Insurance.