Must a hospital in NJ inform me that a provider not participating with my insurance will treat me?

Asked 9 months ago - Pomona, NY

Doctors are now balance billing for services my out-of network plan didn't cover. The hospital is in-network but dr's weren't. I feel I should have been informed.

Attorney answers (1)

  1. Peter Christopher Lomtevas

    Contributor Level 20

    Answered . No. A hospital in New Jersey can be in-network for insurance purposes, but specialists performing individual items of work can be out of network and can balance bill you. That being said, I don't know your particular facts and I must guess. You went in for heart surgery at a hospital that is in-network for your insurance. A cardiologist specializing in a certain facet of your heart had to be consulted, He charges $500 for that consultation. The surgery is all covered but the $500 bill arrives at your door.

    Otherwise, balance billing is very illegal in New Jersey. An in network provider cannot accept a payment from you insurer and then send you a supplemental bill for additional funds.

    Good luck.

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