Question:
medical collection agency problems
A few years ago my health insurer was Aetna US Healthcare. Many of the
providers in my area at that time were starting to refuse Aetna because of
payment practices. My wife had to undergo a procedure at a participating
hospital. My primary care doctor told us to make sure the hospital knows
that any lab work had to be sent to an Aetna participation lab or it would
not be covered. When we spoke to the admitting clerk, we made it known that
we had Aetna and what the doctor told us about lab work. The clerk said to
let the nurses know when we went back for the procedure. We informed the
nurses and they said it would not be a problem.
Well, guess what. The hospital sent the lab work to a non-participating lab
and Aetna refused payment (go figure). I have refused to pay the charges
since the hospital did not meet its contractual obligations by following the
guidelines set forth by the health insurance provider. I went from paying
zero dollars to owing over $800 because of a screw up by the hospital staff.
What are my options here? Am I still liable for the fee even though the
hospital made the error? What is their culpability in this situation?
Answer:
Your problem will be getting someone with enought horsepower in the
hospital to admit it was their error. Do you have anything in
writing, perhaps the admitting clerk made a notation on one of the
forms? Have you tried going back and speaking with those people that
said they would send to select labs? Maybe one of them will remember
the instructions and be willing to support your claim.
Barring that, you are likely stuck, and indeed you almost certianly
signed a financial responsibility form saying you were fully
responsible for all charges.
Good luck and keep us posted on your progress.
