Question:
Has anyone had an in-network hospital sue after insurance paid?

My in-network hosipital is dissatisfied what UHC paid them by their network contract, and now they are suing me for the difference. Any help would be appreciated.    — skip T. (posted on January 31, 2005)

January 31, 2005
I would call UHC, and tell them this. Did you get your EOB in the mail yet for what the insurance co paid the hospital, and what your are resposnible for? It may be your deduction or out of pocket expence. If the insurance co says they should consider it payment infull, the insurance co will go after the hospital and they cant charge you. BUt call UHC and see what they say, it may be your responsibility. If so try to work out a payment plan. Good luck Rosemary
   — wizz40

January 31, 2005
My hospital and doctor we out of network and I understood from the beginning that they would only pay 70%. However, after the surgery was done, UHC paid the bill, then a few days later, changed their mind, and said it was an error, and they didn't consider my surgical institution was a hospital and asked said hospital for its money back!! Denied to pay the whole thing! About $58K ! I sent a registered letter of appeal to my HR and UHC, explained that permission was given for the surgery, plus pre-certification was given to my surgeon and my "hospital" by UHC before it was ever done! How can they decide after the fact that everything wasn't OK? I cited my own employer's Summary Plan Description back to them, also citing that , at the minimum, the "usual and customary charges" should be paid. I guess my letter was good enough , because they paid TOTALLY in full for the whole thing, even though it was out of network. Go figure that one out! In your case, I always understood that if the hospital is IN Network, that means they have contractually agreed to accept what the insurance company pays, and the bills even state "you are not responsible for the difference." By agreeing to the contract with UHC as a network provider, they must accept what is paid by UHC. At least ,that's the way I understand it to work.
   — Anna S.

January 31, 2005
i have UHC also. If they are contracted with a doctor or hospital they CANNOT go after you. It is illegial.
   — Delores S.