If health insurance is refusing to pay for something they should, is the patient ultimately liable?

Frank: If health insurance is refusing to pay for something they should, is the patient ultimately liable?
Would this be a matter directly between the hospital and the insurance company?

Or is this a matter where the hospital holds the patient liable, and the patient holds insurance company liable?

Thanks for the help.

Answers and Views:

Answer by Dan H
Yes, you will have to pay the charges if the insurance company does not pay.

The insurance company always says no to any charge that is not routine. You need to follow the dispute procedure outlined in your policy. You can call your insurance agent if you have one, or call the information line for your insurance company.

The hospital isn’t going to fight for you. You need to do this yourself.

If the insurance company still won’t pay for the procedure after you go through their entire dispute process and you are certain that it was a covered event, you can sue your insurance company.

Answer by Mac
The hospital cannot force the insurance company to pay. If the patient believes he has been wronged, he can sue the insurance company. When you buy insurance the deal is between the insurance company and you. The hospital is not a party to the agreement and hence not a party to the dispute. If the insurance company denies the hospital’s claim, the hospital will charge you. You in turn can take the insurance company to court.

Answer by Bubba
Depending on who decides what “should” be paid. If you have a big bill and the insurance company found in your medical history that you have something in the past that they could claim as preexisting condition, they would try to use it to deny your claim. If you don’t have coverage, that means you have to pay it. Of course you can take them to court, but good luck with that.

Answer by Trapp
You have a few choices, but both cost either money, time or both.

You can fight the insurance company denying a claim, yourself.

You can hire a lawyer to fight the insurance company.

You can pay the bill.

Ultimately what you do is up to you and how much time you feel like getting involved in the dispute. If you feel you’ve got a good case for your claim, then gather what information you can and try to fight it yourself.

In the future, you may want to check multiple health insurance companies before settling on a specific company with sites like – and others. In addition to that you should also check reviews and ratings on claims from each company to get a feel for how each company handles claims and their rating. Sites that help with that include https://www.ambest.com – https://www.claimspages.com/