Legal Question in Health Care Law in Missouri

Insurance will not cover hospital bill

My wife spent two weeks in the hospital last May, Blue Cross initially pre-approved her stay. Thought we were OK, then got sent a $60,000+ bill from the hospital 2 weeks ago, and after following up with Blue Cross, they sent a one-page statement that WE owe the whole bill. I know I should appeal, but is it best to get help from a lawyer through this process so as not to make any mistakes?

Asked on 1/29/06, 6:04 am

2 Answers from Attorneys

Anthony DeWitt Bartimus, Frickleton Robertson & Gorny, PC
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Re: Insurance will not cover hospital bill

I see Jeff Heinrichs has already replied to your email. Jeff is correct on these issues. If you're in the KC area, Jeff would be a good person to start with on this issue.

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1/30/06, 10:00 am
Jeff Heinrichs McLeod & Heinrichs
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Re: Insurance will not cover hospital bill

Hello,

If your insurance company preapproved your wife's stay, there is a good argument to be made that the insurance company could be forced to honor their promise. The helpful information to have is any notes you took during the preapproval conversation or whether you recall the name of the person you spoke to. If you don't have this (and very few people do because they never expect the insurance company to change its mind on them) we can hope that the insurance company has a record.

Without seeing your insurance policy, I am willing to bet that it will be controlled by a federal law called the Employment Retirement Income Security Act (ERISA). Some keys for you to know are that there are very strict procedures and time requirements for appealing and/or filing a lawsuit. If you fail to follow the procedure or meet the time requirement, you may lose even if your argument is valid.

I work on ERISA cases so if you would like any more information, please feel free to contact me at jheinrichs@mclaw.com. Good luck.

Jeff Heinrichs

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1/29/06, 10:21 am

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