No news is good news, but receiving unexpected medical bills is definitely bad! If you have health insurance, were hospitalized, and then received some unexpected medical bills, is it possible that the hospital made a mistake? Has the hospital failed to bill the insurance provider, or perhaps only partially billed the insurance? This can be very frustrating, and it would leave you wondering, “Why didn’t my insurance cover my hospital bill?” or “Why didn’t the hospital bill my insurance?”

Main Reasons Why Your Hospital Failed to Bill the Insurance Company

Patients may not be aware of some of the behind-the-scenes billing issues at a hospital. In recent years, there has been a rise in instances whereby hospitals refuse to bill the health insurance company or with payment co-op systems like Medicaid or Medicare.

The reason is simple: You pay for healthcare benefits, and your insurer has a contract with the medical facility in which the hospital will take on insured patients at a reduced rate. If the hospital doesn’t allow the reduced fees, they could lose all of the patients who are insured under that health insurance company. Uninsured patients are charged at normal or higher rates.

If the hospital failed to bill the insurance company, the reason may be purely profit-based. Hospitals prefer to recover 100% of their rates, and as such they would rather bill the full amount to the other party’s insurance or send you the bill so you can pay in full. In this manner, they avoid accepting reduced payments, and you end up paying for benefits that should be covered under your insurance.

Simply put, however, this is a gray area. While these actions may not be technically illegal, they could have financial implications for the patient. You could be at a disadvantage if you do not have a personal injury lawyer to assist you and point out this questionable behavior.

Unfortunately, the first question most patients ask is, “Why didn’t my insurance cover my hospital bill?” When they discover the hospital failed to bill the insurance, they try to resolve the issue themselves. It is only when they realize that they are being taken advantage of that they approach a personal injury attorney to get them the justice they deserve.

Red Flags: When the Hospital Didn’t Bill the Insurance

If the medical staff asks questions such as if the other party is insured, the names of the other parties, or for a police report, the probability is that they are going to try to recover costs from the other party. If you allow them to follow that route, you may receive less compensation or a lower settlement than the amount you are due.

Other Reasons Why Your Hospital Failed to Bill the Insurance Company

There are some other reasons why your hospital refuses to bill the insurance company or may have failed to bill the insurer, but the truth may be more complex based on your particular case.

Patient Insurance Information

Check that the hospital has your correct details and your insurance information. Simply ensure they have all the necessary information pertaining to your insurance coverage, and politely ask them to submit your claim.

Administrative Errors

If the hospital failed to bill your insurance company, it may simply have been an error. Humans can make mistakes, so there may be data entry issues, computer code errors, or general administration problems. While this shouldn’t result in being your problem, if there are admin errors, the bill may land with you.

This situation could easily be rectified. You could contact the hospital by telephone or via email and ask them, “Why didn’t the hospital bill my insurance?” However, you may get a better response if you physically visit the billing department with your insurance papers and bill in hand. If it was an internal mistake, the bill can be amended and sent to the insurer.

Insurance Payment Disputes

It is possible that the hospital failed to bill the insurance company because they may have existing payment problems with the insurer. If the hospital refuses to bill your insurance because there are obstacles in dealing with them, then this could affect your claim.

What Factors Affect Why the Hospital Didn’t Bill My Insurance?

If you are still asking, “Why didn’t my insurance cover my hospital bill?” it may be important to consider that the problem could have been caused by these factors:

Staffing Issues

They may be understaffed and under immense pressure, merely making a mistake.

Your Insurance Coverage

If you recently changed insurers or insurance plans, it is possible that the claim could not be lodged. Check the terms of your new insurance coverage.

Complex Insurance Plans

If the hospital failed to bill your insurance company correctly, this may have been due to confusion as to who was responsible for the bill. This could happen if you have a complicated insurance plan.

What You Need to Know

The No Surprises Act was implemented in 2022 to protect people from unexpected medical bills. When you have been in a motorcar accident, been the victim of a hit-and-run, or been knocked down on the road, you have an emergency, and the last thing on your mind is checking if the doctor is an out-of-network provider. So, if the hospital failed to bill the insurance company, you may only find this out when you get a surprise bill in the mail. The No Surprises Act is there to protect you from these unwanted headaches, such as when the hospital refuses to bill the insurance.

Key Factors From The No Surprises Act

Emergencies

You should never be put in an embarrassing position where you need to ask questions like, “Why didn’t my insurance cover my hospital bill?” or “Why didn’t the hospital bill my insurance?” There should be no more surprise bills for emergencies according to the No Surprises Act, even if the provider is out of the insurance network. This also applies to emergency air ambulance services.

In-network Coverage

If you go into a hospital that is within your network, you should be protected from surprise bills. This includes even if some of the medical professionals are not part of the insurance network.

Out-of-network Coverage

If the hospital failed to bill your insurance company, you cannot be charged higher rates by an out-of-network provider. They can only charge you the same amount that a doctor in your insurance network would charge.

No Right Waiver

Even if the hospital refuses to bill your insurance provider, no one can force you to waive your rights under the Act in order to pay more for any out-of-network medical care. It doesn’t matter whether you slipped at the mall, were bitten by a dog, or are a victim of crime; you have rights and no one can force you to pay higher rates than required.

What Can You Do If the Hospital Failed to Bill Your Insurance Company?

If you ever have to ask, “Why didn’t my insurance cover my hospital bill?” just remember that there are steps you can take. Here are some pointers to help your situation:

• Check your insurance policy to see what your insurance covers if the hospital failed to bill the insurance company.
• Check if the medical providers are on the list of approved providers or not. This could explain why the hospital refuses to bill the insurance.
• If you should be covered by insurance, approach the hospital to rectify matters. Contact the billing department and ask them to provide reasons in writing as to why the hospital didn’t bill the insurance.
• If the hospital failed to bill the insurance company, you could approach your insurer. Explain your situation to them and point out that you were not expecting or provisioning for this surprise bill. Provide them with all the paperwork so they may possibly intervene and contact the hospital directly to rectify matters.
• File an appeal with your insurer if the hospital still refuses to bill your insurance and your insurer has denied your request for help.
• You can file a complaint with the South Carolina Department of Insurance:
  • Email: consumers@doi.sc.gov
  • Telephone number: 803-737-6180
• If you are not getting any satisfaction from either the hospital or your insurer, speak to a local health insurance attorney to assist you with your case. They can review your situation and help you prepare for court if you have a valid legal claim.

What Can a Skilled Personal Injury Lawyer Do to Help You?

If the hospital failed to bill your insurance, you should hire a personal injury lawyer. They will thoroughly assess your matter and investigate the situation. They will also communicate with the hospital and insurance company, ask the right questions, and gather evidence if there is a delay or refusal to bill the insurer. They may send a letter of demand requesting that the hospital bills the insurer. They will negotiate matters for you, such as reduced bills or higher settlements.

If the hospital still refuses to bill the insurance, your lawyer may advise filing a complaint with regulatory authorities like the Centers for Medicare and Medicaid Services (CMS) or state insurance departments. Depending on the facts of your case, your lawyer may also file a lawsuit, and he would fully prepare you for the court case, supporting you through every step of the personal injury claim process.

Quick Tips

If the hospital failed to bill the insurance company, keep these pointers in mind:

• Remember to document everything that happens, including keeping copies of emails, bills you have received, times of calls, and/or hospital visits. Record details such as the names of people you spoke to, their positions, their responses, and always record the dates and times when you made contact.
• Don’t give up trying to find a resolution. Pursue your claim politely but persistently.

Get The Compensation You Deserve With A South Carolina Personal Injury Lawyer

If the hospital failed to bill your insurance company, Thomas Spiro at Spartan Law is the lawyer to call. He will zealously advocate for your rights and fair compensation. Dial 864-777-1000, and you can speak directly with a lawyer today. Thomas Spiro will travel to you if you are injured and unable to travel. And, at Spartan Law, we fight hard to win because you only pay when we win your case. Get a lawyer on the phone now because Spartan Law is ready to fight for justice for you.