Was Told Surgery Is In-network, Now $80,000 Hospital Bill.

Hi all,

I’m hoping to get legal advice and what kind of attorney I should contact because I refuse to believe I don’t have some kind of legal protections here.

I had jaw surgery in May 2024 and spoke to financial counselors at the clinic before. They assured me my insurance is in-network with them and gave me an out-of-pocket estimate of $5600. I have this in writing from them, detailing all of my insurance details and my portion. I was told I did not need a prior authorization and trusted that they knew what they were doing so we proceeded with surgery. The day after surgery when I was discharged the hospital gave me my receipt for my facility charges payment. Once again, it lists my insurance, their portion (which was almost all of of it) and my portion which was $2300 which I had already paid. I leave feeling great about the financial aspect of my surgery.

A month later I start getting bills showing 0$ insurance payment. Long story short, the clinic made a grave mistake and did not realize I had emergency coverage only for out of state care (I got my surgery in a different state than I lived in due to recommendation from my orthodontist). I first got a $10,000 bill for physician services and in December got an $80,000 bill from the hospital. I appealed with my insurance but it was rejected since their policy is clear, and they were never involved. The clinic’s financial counselors lied to me about contacting them.

I have filed my case with the “no surprises act” help desk but have not yet heard back for a couple of weeks now. I have involved my surgeon who has been fighting for me and speaking to the hospital and also has already written off his charges (physician charges). I really appreciate my surgeon caring enough to try to fix this for me, but I am worried if the hospital will comply. If not, what kind of attorney do I contact here for a consultation? I am in contact with the financial advocate for the hospital who has escalated this to the highest level of management and supposedly they will be deciding on my case within the next couple of days. I really hope they rule in my favor but I need to prepare for the case that they don’t. Under no circumstances will I pay 80k to the hospital for being conned into this surgery.

Therefore, what kind of attorney should I contact and do you think my case has merit? Thanks.