Patient forced to pay above and beyond his out-of-pocket max

Patient forced to pay above and beyond his out-of-pocket max (Photo: KUTV)

(KUTV) A short walk down the stairs was a brutal ordeal for Robert Squirer. His knee was absolutely killing him.

"It was like bone on bone and it was bothering me a lot," he said.

His doctor recommended surgery to fix the problem and Squirer chose to act quickly because doing so would save him money.

"I've met my max out of pocket and supposedly [the insurance company] should pay everything,” he said.

Squirer’s knee now feels much better. He wishes he could say the same from his wallet. His insurance company is refusing to pay a portion of the hospital bill telling him that the hospital lopped on extras that weren’t necessary to the surgery.

Squirer appealed to both his insurance company and the hospital but to no avail.

When the insurance company refused to pay, the hospital demanded Squirer pay the $2188.91 balance.

Get Gephardt reached out to Jordan Valley Hospital which indicated that what showed up on Squirer’s bill is normal with the knee surgery and they stated that the insurance company should have paid.

Squirer’s insurance company, Choice Benefits, refused to comment stating it would violate Squirer’s privacy – even though Squirer was perfectly willing to give the insurance company permission to answer questions.

Squirer ended up paying the hospital bill in order to avoid being sent to collections and is now filing a complaint with the Utah department of insurance which investigates and can compel an insurance company to pay a claim when they ought to pay.

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