What do I do if my Insurance Company won't pay my Hospital Bill?
Answer:
Health insurance plans vary widely in their


covered expenses, and sometimes a patient is not fully aware of just what things ARE covered.  In addition, some medical costs charged may fall into coverage categories which may have confusing eligibility rules.

For example, an ambulance ride may not be covered if the insurance company deems that the reason given for needing the ambulance does not meet their eligibility definition of "emergency".

Unfortunately, the insurance companies have the distinct luxury of being allowed to practice what I like to call reverse insurance fraud.  That is, if the insurance plan details and fine-print are not completely specific as to what items are covered and what items are not covered, some of the companies seemingly attempt to stretch the eligibility rules in their favor, leaving the consumer with unpaid medical bills and the potential consequences associated with that.

While I cannot find fault with insurance companies' attempts to maintain their profit margins, I do reject the idea that one must hire a lawyer to fight for something that should have been part of the health insurance coverage in the first place.

Sometimes, the insurance company's reasons for not paying a particular bill might be a simple error in the billing procedure.  Most medical billing is standardized with codes and categories designed to minimize confusion.  Unfortunately, since so many codes may overlap one-another, it can still be difficult to properly identify and categorize the charges.

For more precise assistance for particular circumstances, contact your State Department of Insurance or Insurance Commissioner's office.
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