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Insurance Neglecting to Pay a Medical Bill

I was told my Cigna insurance would cover my medical bill, but later found out the bill was never paid. Now I owe almost $1,000.

Bill - when I went to Loma Linda dermatology group, I was told there that my insurance was accepted and that they were contracted with my insurance, Cigna. I received a bill from Cigna and called the clinic immediately and repeatedly. I was told "not to worry, the bill is being taken care of. Cigna promised to take care of all of out patients during this period of time, it was a paperwork issue". Two years later the hospital sends my account to the collection agency and are still not denying that they told me not to worry. Instead they are telling me that they tried with the insurance company and that I am responsible now. I think this is unethical. It was not a medical emergency of any sort. I just took their word that they apparently had paperwork issues with Cigna at the time. Now I am stuck with almost a thousand dollars in old medical bills and can't afford them.

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Bill's Answer
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(6 Votes)

Updated: Oct 20, 2014

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Highlights

  • Patient is responsible for paying medical bills
  • Doctors handle billing as convenience only
  • Fighting an unpaid claim can be costly

Unfortunately, you may not have much recourse in this situation. When you sign an agreement for medical treatment, you are committing to pay the full cost of the services provided; if your insurance refuses to pay the bill for whatever reason, you are responsible to the provider in full. If you think that your insurance should have paid the bill, that is really between you and your insurance company; you will likely be expected to pay for the service and then seek reimbursement from the insurer if the service was covered by your policy.

Although we have all become accustomed to the idea of having our insurance pay our doctors directly, providers bill your insurance as a convenience to you and to increase the likelihood that they will be paid. Ultimately, you are responsible for the cost of the services provided, and if your insurance will not pay, you are probably on the hook. While I understand that the provider told you that Cigna would pay this bill, the contract you signed for treatment almost certainly places the onus for paying the bill on you.

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If you do not want this debt to end up in collections, which could potentially damage your credit rating, among other negative effects, you may be forced to pay the account yourself; you can then file a claim with Cigna if you think that it should have paid for this treatment. You may find yourself fighting an uphill battle, especially with the age of this claim, but I think that the insurer, not the medical provider, is where you should be focusing your efforts to resolve this debt.

If Cigna is unwilling to pay the claim, you may want to consult with an experienced insurance attorney to determine if you have grounds to file legal action against the insurer. However, you will need to consider that the cost of taking legal action to force Cigna to pay this debt will likely far exceed the original amount of the claim; it may make more financial sense to simply negotiate payment on the debt and take this incident as a lesson that you need to verify that any provider you use in the future is fully approved by your insurer.

I wish that I had better news for you, as I know that this situation is extremely frustrating. Unfortunately, you are likely responsible for paying the debt, and will probably need to do so if you do not want the account to lead to further collection efforts. I wish you the best of luck in resolving this dispute, and hope the information I have provided helps you make better money decisions.

I hope this information helps you Find. Learn & Save.

Best,

Bill

Bills.com

3 Comments

Recent Best
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  • NR
    Jul, 2010
    Nelson
    How can we ever trust insurance companies. The problem is that there is so much red tape that insists that we are insured. I am having bad experiences with my apartment which we only live in a couple of times a year. I have been ripped off twice by the insurance when trying to get tenant damages...I still have to pay the insurance though..CRAZY
    0 Votes

  • BA
    Feb, 2010
    Bill
    Your story is common. You or your spouse need to become a patient advocate not only to make sure your spouse gets the care needed but also to make sure the insurance company pays for what is medically necessary. To get started, see the Patient Advocate Foundation.
    0 Votes

  • CO
    Feb, 2010
    Carole
    My husband was admitted to hospital in Benidorm in September 2009. We were fully covered by our insurance but they are fefusing to pay the FULL costs because they don't think he needed to be in hospital for as long as he was ( Sun to Thurs )That was up to the medical profetion we had no say in the matter. He was in intensive care for 2 days then transfered onto the ward for a further 2 day's for more tests. Since coming home from holiday my husband has had further tests and he's now found out he's to have a triple heart bypass in the next few weeks. Were do we stand in the matter?
    0 Votes