Jacksonville, FL asked in Health Care Law, Insurance Bad Faith and Insurance Defense for Florida

Q: Health Insurance deny my claim stating is out of network but paid previously a claim ?

Please help ? My insurance processed a wellness claim at a different location of a hospital with the same name. Later, I received a referral for a specialist and had sonograms at the same hospital but in a different location. Despite being labeled as an out-of-network service by my insurance, the hospital's accounting department confirms billing under the same network for all locations.

Despite my attempts, contacting supervisors and submitting disputes yielded no follow-up or resolution. The hospital's appeal was denied, and during admission, staff assured me of no out-of-pocket deductibles. I never received an upfront estimated bill, as the agent guaranteed zero cost based on my coverage.

Given these circumstances, I'm unsure of my rights, especially with both the insurance company and hospital being uncooperative. It feels unjust to potentially face a hefty bill despite consistently paying insurance premiums. I appreciate any assistance in clarifying my rights.

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY

A: Only a Florida attorney could advise, as a good portion of insurance and consumer laws are governed by state provisions. But your question remains open for three weeks. Until you're able to consult with a local attorney, you could check the backsides of any denials or EOBs - they sometimes outline options, whether arbitration, civil court, or other remedies. Good luck

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