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Medical liabilty


Methuss
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Here's an interresting hypothetical for the lawyers...

You go to a hospital in your insurance network.

The hospital runs some tests and sends the specimins out to a lab that is not in your network without your knowledge.

The lab charges more than reasonable and customary charges exceeding what the insurance company will pay.

The lab bills patient for unpaid balance.

Who is liable for the lab costs? The patient was given no choice in the matter and did not ask the samples to be sent to that lab. The hospital chose the lab. Shouldn't this be a debt the hospital incurred since they subcontracted the work?

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Recent experience here. Someone very close to me was in the hospital 2 weeks ago and recd a bill last week for services rendered. Most will be paid by insurance, however when you are admitted, you are asked to sign paperwork agreeing to any charges, regardless if covered or not. Even if the lab's fees were unreasonable, the hospital did what they believed to be in the best interest of the persons health.

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OK add one more detail to the mix:

The hospital was told what lab service to use by the insurance company.

On a side note, this is perturbing me. I don't know of any idustry other than medical that subcontracts work and has the subcontractor bill the consumer directly. If you hire a general contractor to do a basement remodel, you pay the general contractor and he in turn pays his subs. My agreement is with the general contractor, not the sub.

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OK add one more detail to the mix:

The hospital was told what lab service to use by the insurance company.

Was there an in-network lab locally the insurance company could have directed the hospital to? That's the crucial piece of info.

If so, I'd say the difference in cost and coverage should be paid by the insurance company and that your argument is with the insurance company, not the hospital.

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Didn't want to taint the question with any bias in my favor.

The lab the hospital was instructed to use handles everything including specimin pickup. All the hospital has to do is call a number. The hospital has used this service in the past as instructed. In this case, they did not after being explicity told. They sent it to an unauthorized lab. Heck, they even have the number on the photocopy of the insurance card, which also says to use this particular lab.

I guess I'll have to go in person to the hospital business office to deal with this. IL attorney General office says this is the most common consumer complaint that they have to mediate about hospitals.

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The hospital has used this service in the past as instructed. In this case, they did not after being explicity told. They sent it to an unauthorized lab. Heck, they even have the number on the photocopy of the insurance card, which also says to use this particular lab.

I guess I'll have to go in person to the hospital business office to deal with this. IL attorney General office says this is the most common consumer complaint that they have to mediate about hospitals.

Dang, well, it sounds like you DO have a right to be angry at the hospitals. Gah. Tests can be freakin' expensive.

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Yeah. Several hundred dollars worth from my wife's 4 day stay at the birthing center. All sent to the same unauthorized lab. Lab used is also 2x reasonable and customary cost.

just found out hospital never gave my wife copies of anything she signed. Great.

Unless there is something my wife signed to the contrary, this is how I see it:

I have no contract with the lab they used. The hospital does. If the hospital wants to use an out of network lab, then that's their liability when an in-network option was provided and required to be used.

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