Medical bill question

[slym]

In September, I was on a 28 day cardiac monitor from Lifewatch. Before they sent it in the mail, they called me and indicated that they had verified my insurance coverage, and that I would have a $200 deductible to pay. I did not receive a pre-authorization from the insurance company, but thought that it must not have been needed, as not all tests, etc. must be pre-authorized and this was not on the list of things that needed pre-authorization in our insurance handbook. I thought that if it needed that, Lifewatch would have been informed when they verified my coverage.

Long story short, the claim has been denied, stating that it is experimental or investigational. I am going to appeal the claim, but I feel that Lifewatch has misrepresented or flat out fraudulently mislead me. It even states on their website:
What to Expect:
LifeWatch will verify coverage with your insurance company.
LifeWatch will phone to inform you of your insurance coverage.

And on their FAQ page:
Will my insurance pay for this test?
LifeWatch is a participating provider with most insurance companies, including Medicare. We will contact your insurance company to verify your benefits and coverage for LifeStar ACT. LifeWatch will call you to inform you of your coverage and schedule the delivery of the ACT system.

If my insurance appeal is not accepted, I do not feel that I should owe the entire balance of this bill - $4,500! Do I have any defense or recourse in this?
Thank you for any help/advice!

 

[jharris352]

I would refuse the bill except for $200. They sent the monitor out after verifying that your insurance would pay. It's their error and not yours.

 

[slym]

That is what I'm hoping to do. I just don't know if I have any legal basis to do so. I know that I received the service, and should be obligated to pay, but I also feel that they essentially erred and did not completely make sure this particular test was covered. What good is telling their customers they will verify benefits if they do not do it completely? Theoretically they could tell all their customers that it's been verified, knowing they would be liable for the bill if insurance doesn't come through. What a great way to ensure a that customer won't say, sorry, I can't afford this test.

 

[jharris352]

That is what I just told you. You do have a legal basis to say that you only owe the $200. They are the ones that checked with your insurance. They are the ones that said your insurance would pay and that you would only have to pay the $200 delectable and therefore you do not owe them anymore than that. They didn't give you the test and say, we "Think" your insurance will pay. If they don't you owe us. They gave it to you on the basis that you would not pay for it your insurance would.

That is your legal basis for not paying. You don't owe the money because you never agreed to pay it. You don't owe the money because there was never a meeting of the minds that you would owe it. In fact they told you that you would not.

 

[slym]

Thank you for the explanation. That helps a lot and gives me hope that I'll be able to resolve this with them.