Legal Question in Health Care Law in Georgia

I went to a sleep center to get help with my apnea, the doctor told me I'd need to get at least one sleep study done. But first, I requested that the Sleep Center first check my coverage, and they did, their financial person told me that It would just cost me my standard co-pay of $35. I had my 2 sleep studies done and I have a bill for $384 for one visit, and $211 for another visit. I spoke with the financial person as this not what I expected, and she states this is what they were told by the insurance company. She gave me a reference number. I called the insurance company. The insurance company (seemed to have) looked up this call and said what they were quoted 80% coverage. Obviously someone made a mistake here, but I wouldn't have gotten these done at this time if I knew about the cost. Who's responsible

Asked on 7/18/12, 9:55 am

3 Answers from Attorneys

John Jackson Law Office of John A. Jackson, P.C.

You are.

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Answered on 7/18/12, 10:04 am

Scott Riddle Law Office of Scott B. Riddle, LLC

As the provider likely made clear through forms, signs or otherwise, you are responsible for full payment. The may try to get paid from the insurer, but that is a convenience not an obligation. You also have the obligation to know what your insurance covers and to confirm this with them directly if there is any doubt. Insurance is a contract between you and the insurance company, not with the doctor, but it appears you left it up to the provider to check for you.

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Answered on 7/18/12, 10:43 am
Glen Ashman Ashman Law Office

You're always liable for your own bills. While many health providers attempt to assist with insurance, it is your responsibility to verify coverage.

As a personal comment, I am both a lawyer and have sleep apnea. My sleep study saved my life as sleep apnea, untreated, can be fatal. The amount you are complaining about in minute compared with your life. Best of luck with your treatment!

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Answered on 7/18/12, 12:01 pm

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