My question involves insurance law for the state of: Texas
My question deals with BCBS denying insurance claims from the NICU due to the doctors that manage the NICU not being in network with my insurance company (BCBS) due to low reimbursement rates. My wife went into pre-term labor at 7-months and was admitted to the antepartem department at our hospital. We had to be admitted to the hospital at 1am due to the preterm labor conditions being so severe. During admission, my wife who was in extreme pain had to sign all of the admission paperwork. Me, as her husband, was not allowed in to assist her due to HOEPPA laws according to the charge nurse. At 11am the next day, her doctor delivered the baby 10-weeks early at which time our daugther, being born at 3.5lbs and 10-weeks early, was admitted to the NICU within the same hospital. Our daughter stayed in the NICU for 47-days. Here is the problem. My wife's doctor and the hospital itself is in network with our insurance provider, Blue Cross Blue Shield of Texas. All bills from those two entities were paid. However, the doctors that cared for my daughter in the NICU choose not to be in network with BCBS due to what they claim is unusually low reimbursement rates. When there bill was submitted to BCBS it was paid out of out network rates. I was balanced billed for approximately $50,000. In researching this issue, I learned that my wife while being admitted (recall that she was in extreme pain) signed a form that detailed that his particular doctor group was most likely not in our insurance network. I have appealed the issue to BCBS and they have denied paying any more to this group. In discussing the issue with the doctor group directly, they have either offered me 20% off the bill or the opportunity to join a class-action lawsuit against BCBS and they will foregive the bill. At this point, I cannot join this suit as BCBS also provides insurance to other employees at the bank I run and therefore "cannot bite the hand that feeds us".
My question is this. Do I have any recourse against anybody in this situation? I feel the hospital made my wife sign forms under duress that morning, the insurance company evidently reimburses at lower than national averages for this speciality care and the doctor group is being unreasonable in joining the BCBS network despite numerous attempts. Thank you for the feedback.