What to do about an insurance reimbursable that is too low?
Question Details: My wife had medical procedures at a hospital and paid about $4,000. She submitted claims to the insurance company. The insurance company reimburses procedures but the allowable amounts are only a third of what we paid. The hospital says that since we paid upfront, they will not reimburse the difference, despite their contract with the insurance company. The insurance company says that they can only reimburse up to their contract with the hospital, and it is not their problem that the hospital overcharged us. My question is who is at fault here, if anyone, and how can we get our money back?