Legal Question in Consumer Law in Florida

My wife went to have an electrocardiogram test at a clinic. She talked to Bcbs first and they said it was a $60 co-pay. The clinic said they do that at the hospital, highlighted her coverage in yellow--the sixty dollar co-pay--so she proceeded on to the hospital. When she checked in the attendent said it was a $60 co-pay. My wife asked her three times are you sure? She said yes, put the $60 on her card, was handed her receipt which showed she paid in full and she proceeded on to the test. Two months later she gets a bill from the hospital which says she is responsible for the entire amount. She would have never had the elective test done if she was told it was not covered. We simply can't afford it. It seems the hospital totally misrepresented the cost which borders on fraud. A health advocate said if she had it done at a clinic it would have been a co-pay, but because she went to the hospital she has to pay her deductible first. What recourse do we have and is what they did legal?

Asked on 9/10/15, 10:07 am

1 Answer from Attorneys

It is difficult to fully answer your question without seeing all the documentation, including how the claim is being billed and a review of your policy. For starters, however, you should immediately call BCBS to explain the situation and state you would like to file an appeal. Gather all the documentation you have and put the appeal in writing along with the documentation supporting your case (e.g., the highlighted $60 copay amount).

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Answered on 9/14/15, 12:06 pm

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