Despite giving insurance info to hospital, they never mention being out of network. I am billed $40,000. Can I take it to court?

Asked about 1 year ago - Union City, NJ

We had a baby recently and even though we provided insurance information, at no point we were informed that the hospital was out of network. After 6 months, they sent us a bill of approx. $40,000, apparently after their negotiation with insurance failed. Telephone records obtained from the insurance shows that hospital got to know about being out of network the next day, but they still didn't inform us.

I feel the hospital is at fault for not checking our insurance on time and also for not informing us know after they found that out. Aren't the hospital legally required to inform the patients, if the hospital falls in our insurance? It wasn't an emergency either! The doctor did an ultrasound and decided it will be better to do a C-section. Can we take this to the court? Please advise

Attorney answers (2)

  1. Lewis Andrew Lefko

    Contributor Level 7


    Lawyers agree

    Answered . You are responsible for your medical care and reading and understanding your health insurance policy and identifying network participating providers. Hospitals don't "find out" if they are out-of-network--hospitals are in-network if they sign contracts with the health insurance company and out-of-network if they don't.

  2. Leonard Roy Boyer


    Contributor Level 16

    Answered . To determined if you have a valid case against the hospital more facts need to be discovered. You should consult a local attorney. Good luck.

    Leonard R. Boyer, Esq. 201-.675-.5577. If you found this Answer helpful, please mark it as "Best Answer" Please be... more

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