Legal Question in Insurance Law in Georgia

Prior to the birth of my son, I made certain that my obstetrician, my son's pediatrician, and the hospital where he was to be born were within the "network" for my insurance PPO. This was important to me, because mine was considered a "high risk" pregnancy. I have a 90/10 family plan, so after a $500 deductible (per family member), I should owe 10% of the total bill. The delivery went well, but my son ended up in the neonatal intensive care unit on our second day in the hospital. He remained there for 4 days. Costs for his delivery, pediatrician, and hospital stay per my explanation of benefits were estimated at around $14000. Now I have recieved notice that the hospital "contracts" with an out-of-network provider to care for its neonatal ICU patients, and that I owe $2125 to this provider alone. A thousand dollars of this charge is considered a secondary deductible. I was never told that such a scenario could exist, and want to fight it. What are my rights?


Asked on 3/29/10, 9:27 am

2 Answers from Attorneys

Scott Riddle Law Office of Scott B. Riddle, LLC

Your "rights" are primarily found in your insurance contracts, which we do not have. What you were told or not told does not change that.

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Answered on 4/03/10, 9:33 am
Glen Ashman Ashman Law Office also dba Glen Ashman Attorney

The bill is your responsibility and what you were told doesn't change the language and exclusions of the policy.

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Answered on 4/03/10, 9:48 am


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