Last fall, my son was admitted to ER at a hospital which is in-network with our company’s insurance. They did tests, then the doctor prescribed drugs and released him after a couple hours. We already paid the hospital $1300 which is the contracted rate for their services. Just recently, the doctor sent a bill for $1800 which got rejected by insurance as “out of network” so we owe the whole thing.
Connecticut has had a law in effect since 2015 (link below). (this is before Federal Surprise Billing went into effect Jan 1). it says in part “If emergency services were rendered to an insured by an out-of-network health care provider, such health care provider may bill the health carrier directly and the health carrier shall reimburse such health care provider the greatest of the following amounts: (i) The amount the insured’s health care plan would pay for such services if rendered by an in-network health care provider; (ii) the usual, customary and reasonable rate for such services; or (iii) the amount Medicare would reimburse for such services“, which for this procedure # 99285 is about $300 by Medicare or my insurance company’s contract rate for in-network.
My insurance company won’t pay anything and the billing company won’t change the bill. Do I have a case? If so, would take one of them to small claims?
https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-477aa
submitted by /u/Lou__Vegas
[link] [comments]Last fall, my son was admitted to ER at a hospital which is in-network with our company’s insurance. They did tests, then the doctor prescribed drugs and released him after a couple hours. We already paid the hospital $1300 which is the contracted rate for their services. Just recently, the doctor sent a bill for $1800 which got rejected by insurance as “out of network” so we owe the whole thing. Connecticut has had a law in effect since 2015 (link below). (this is before Federal Surprise Billing went into effect Jan 1). it says in part “If emergency services were rendered to an insured by an out-of-network health care provider, such health care provider may bill the health carrier directly and the health carrier shall reimburse such health care provider the greatest of the following amounts: (i) The amount the insured’s health care plan would pay for such services if rendered by an in-network health care provider; (ii) the usual, customary and reasonable rate for such services; or (iii) the amount Medicare would reimburse for such services”, which for this procedure # 99285 is about $300 by Medicare or my insurance company’s contract rate for in-network. My insurance company won’t pay anything and the billing company won’t change the bill. Do I have a case? If so, would take one of them to small claims? https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-477aa submitted by /u/Lou__Vegas [link] [comments]Read Morer/HealthInsurance