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Medical Bill received over a year later- do I have any recourse?

Defamation Law Discussion Forum

Medical Bill received over a year later- do I have any recourse?

Postby salvadore94 » Sat Jul 14, 2012 6:01 am

Just received a bill close to a year and a half later. The doctors office stated that the car insurance provider picked up part of it but the balance is still just over $700 and they want to be paid. At that time, I provided them with the back-up insurance (major health insurance) BUT according to their own office Manager, as well as my insurance company, the doctors office failed to submit the claim "in a timely manner" so it was denied. The doctors office is trying to argue they thought the first insurance (car) would cover everything. From the beginning they had both insurance cards but only submitted one. I specifically told them to do whatever they had to do to make sure we did not have to pay e.g., submit it to both, to ensure that something like this "surprise" would not happen. They assured me it would be fine but apparently now it is not.

At this point, what do you recommend I do as responsible and prudent next steps? e.g., 1. Make very small monthly payment "in good faith" until this gets resolved? 2. Escalate this legally ASAP and try to get it dismissed in small claims court? 3. Just pay it?

I am sure there was something signed from them that says ultimately the patient is responsible for payment but still, this just seems wrong so I was wondering if anyone has any experience with matters like this and WHY does it take a year and a half to get a medical bill? No one wants to tell you how much things will cost or how much insurance will cover- it's ridiculous and in the end, it's the consumer who end up paying.

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Joined: Fri Apr 01, 2011 6:14 am

Medical Bill received over a year later- do I have any recourse?

Postby gerard » Sat Jul 14, 2012 6:06 am

Yeah, it seems wrong to me too... I had a similar situation. A physical therapist didn't bill me for over 14 months and when the bill came I couldn't even match it up to my visits.

Have you contacted your health insurance company to see what they consider "in a timely manner"? Typically it's 2 years... and is there a way that you can appeal this decision?
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Joined: Thu Mar 31, 2011 10:09 am

Medical Bill received over a year later- do I have any recourse?

Postby forde » Sat Jul 14, 2012 6:11 am

"small monthly payment" doesn't work. There is no rule that says you can pay $5 a month and they can't sue you. When you got the service you signed paperwork that said you would pay if the insurance didn 't. You are stuck.
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Medical Bill received over a year later- do I have any recourse?

Postby kyledyr » Sat Jul 14, 2012 6:13 am

They are not required to submit the claims, even if you specifically tell them to do it. If you want to ensure that someone submits the claims, then you must submit them yourself, without relying on the doctor's office to do it.

Just pay it.

They are not required to send bills within a year, or to send them ever. Unless you submit the claim on time, yourself, you are required to pay, even if they never send a bill.
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Medical Bill received over a year later- do I have any recourse?

Postby shashank » Sat Jul 14, 2012 6:14 am

Generally speaking, in the end it’s considered the patient’s responsibility to make sure that all medical bills are submitted to the health insurance company for reimbursement. However, the process is complicated and largely in the hands of medical providers, so things like this can happen. When they do happen, it stinks.

To summarize the problem as I understand it, the auto insurer paid a portion of your medical bill. The remainder should have been submitted to your health insurance company, but the medical provider was slow to do so. When they finally did, the claim was denied because it wasn’t submitted in a timely manner. Now the doctor’s office is billing you for what was really their oversight.

Here’s what I’d recommend:

First, contact your health insurance provider, explain the situation step by step, and ask if they will make an exception and process the claim despite the fact that it was late. They may be more inclined to do so if you – rather than the doctor’s office – ask them to.

If they won’t process the claim when submitted by the doctor’s office, ask them if you can pay the bill to the doctor’s office and then submit the claim to your insurer yourself. They may be willing to reimburse you directly.

Finally – ask your insurer if the doctor’s office is in-network and, if so, if they’re contractually allowed to bill you like this. If they’re an in-network provider, they may have been contractually obligated to submit the bill for you in a timely manner. If they failed to do so, they may be contractually obligated NOT to bill you for it, but just to eat the loss.

If none of these options works, well, then I’m afraid I can only recommend that you pay the bill yourself. Otherwise, you’ll likely get sent to collections, it could affect your credit, and it would probably be more trouble taking it to court than it’s worth. In the end, if the doctor’s office isn’t contractually prevented from billing you for a claim they were late to submit, the charge likely becomes your responsibility by law, since services were rendered to you.

Best wishes.
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Re: Medical Bill received over a year later- do I have any r

Postby emmahunter588 » Tue Dec 11, 2012 2:26 am

I think the best thing for you to do is to contact your insurance provider. To know more about medical billing, visit this site: http://advantmedicalbilling.com/patient-account-representative/
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