Question

A few months later, you have a short hospital stay. The hospital filed a claim directly with your insurance company and sent you home without collecting any payment. You were shocked to receive a bill later from the hospital in the mail. The insurance company denied your claim, and the bill says that you owe the hospital $23,000.

You believe that your hospital stay is covered by the terms of your insurance policy. What’s the next step you should take?
Question 5 options:

Pay the $23,000 hospital bill.


File an appeal with the insurance company.


File a complaint with the hospital.


Sue the insurance company in court.

Answer 1

File an appeal with the insurance company.

Explain: insurance denials are usually appealed first. Get the Explanation of Benefits (EOB) and denial letter, gather medical records and any physician statements showing the stay was covered/medically necessary, submit a formal internal appeal within the insurer’s deadline, and ask for an external review if the internal appeal is denied. Don’t pay the full bill while you’re appealing. Contact the hospital billing office to let them know an appeal is in process so they may temporarily hold collection action.