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  1. #1
    Join Date
    Jan 2018
    Posts
    3

    Question Hospital Provided $0 Estimate but Charged $450 After Procedure

    My question involves malpractice in the state of: LA
    Hi,

    I visited St Francis hospital in Mid October to get x-ray done for my wrist. My doc told me that x-ray was not required but I could do it for just in case. At admission in St Francis, I provided my medical insurance card and asked how much I'd need to pay for x-ray, so that I could decide if I wanted to do it or not. I was provided with Estimate as $0 and estimate sheet mentions "Based on the services estimated and your insurgence benefits, it is estimated that you will owe $0.00 for your services". So based on this estimation and verbal confirmation I went ahead and did x-ray. But now hospital is sending me bill of $452 and saying that there was mistake at their side and I was provided 'estimate' but actual cost is $452.

    I think, this is not fair. I wanted to know beforehand how much I'd need to pay and only after their confirmation I went with not urgent x-ray.

    Am I liable to pay this money or can I take legal course to file a case against hospital as it is continue to bother me?

    Thanks for any suggestions.

    -Tushar

  2. #2
    Join Date
    Oct 2016
    Posts
    3,231

    Default Re: Hospital Provided $0 Estimate but Charging $450 After Procedure

    Odds are you will be liable for the payment. Did your insurance not pay anything?

  3. #3
    Join Date
    Jan 2018
    Posts
    3

    Default Re: Hospital Provided $0 Estimate but Charging $450 After Procedure

    As per insurance, it was towards deductible. Hospital did the mistake in estimation. I'd have avoided procedure or looked out for better options had they told me real estimation. An estimation should have given a fair idea about how much I owe.

    Thanks for you reply!

  4. #4
    Join Date
    Jan 2006
    Posts
    38,728

    Default Re: Hospital Provided $0 Estimate but Charging $450 After Procedure

    The hospital provided an estimate based on information provided by you. They aren’t privy to all the fine details of your contract. You were also probably given a statement that it was only an estimate and not a contract.

    If you want to know what your insurance would pay, you need to speak with your insurance provider who has the up to date details of your account.

    Basically, the hospital saw that the procedure was covered, presumably, 100%. It appears it is still correct in that assumption. Whether you have met your deductible so your insurance would pay the hospital or apply to your deductible is something the hospital apparently is not privy to.


    Welcome to the world of the confusing relationship of patient, provider, and insurance. I’m not sure anybody feels it works the way we all think it should.

  5. #5
    Join Date
    Jan 2018
    Posts
    3

    Default Re: Hospital Provided $0 Estimate but Charging $450 After Procedure

    But my estimation sheet says payer name as MY_INSURER_NAME and deductible remaining $0. So should not I know around how much I need to owe before I take any service?

    Thanks!

  6. #6
    Join Date
    Mar 2013
    Posts
    17,135

    Default Re: Hospital Provided $0 Estimate but Charging $450 After Procedure

    Quote Quoting tushars2001
    View Post
    But my estimation sheet says payer name as MY_INSURER_NAME and deductible remaining $0. So should not I know around how much I need to owe before I take any service?

    Thanks!
    Might as well just pay it. You aren't going to win this. All they'll do is send you to collections and trash your credit while the bill keeps growing with late fees and interest.

    I went through the same thing a few years ago when I tried to find out in advance what a procedure would cost. Long story short, what I ended up paying was a lot more than the "estimates" that I got from the doctors and my insurance company.

    Quote Quoting jk
    View Post

    Welcome to the world of the confusing relationship of patient, provider, and insurance. I’m not sure anybody feels it works the way we all think it should.
    Ya got that right.

    35 years in the insurance business and I can't figure it out either.

  7. #7
    Join Date
    Oct 2016
    Posts
    3,231

    Default Re: Hospital Provided $0 Estimate but Charging $450 After Procedure

    The only way the hospital would know if you have satisfied your deductible not not is if you or your insurance company told them. So, if there was a charge because your hadn't satisfied your deductible it is your fault or your insurance company's.

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