The doctor didn't charge the health insurance in time, am I liable?

Question

I got a bill for an emergency room visit for one of my kids. It was the weekend and that was where the insurance told us to go. Luckily no stitches needed. Fast forward 7 months and I get a bill for over $700. On the bill it says that they charged the health insurance company but they did so only last month, over 6 months after the incident. The decline says "time limit expired". The bill would have been covered in full, less the already paid copay, had it been filed on time.

So am I liable for paying this bill since the Doctor's office messed up by not charging in time?

score 14 · Answer 1 · answered Apr 09 '13 at 18:46

I work for a health billing company. It is completely the provider's responsibility to bill your health insurance in a timely manner if they have your health insurance information on file (it sounds like they did). If you can gather a copy of your EOB (Explanation of Benefits) from your health insurance, it will likely say something to the extent of: "claim was submitted after the timely filing limit, therefore no payment was made. The patient is not liable for the remaining balance." Don't let the hospital/physician bully you into paying for something they should have submitted to the insurance in the first place.

score 9 · Answer 2 · answered Feb 01 '11 at 16:35

I was in a similar situation years back and I refused to pay the bill. My point of view was that I provided the hospital with all information needed to submit the claim in a timely matter and that I should not be held responsible for their failure to do so. In the end they waived the charges. So while technically I might have been responsible for paying the charges, in reality I think they decided it wasn't worth the hassle of making me (I would have fought it all the way up to the top). Not sure that I would recommend this approach though :)

score 6 · Accepted Answer · edited Feb 01 '11 at 15:22

6

This has a straightforward answer. It's likely that your doctor and the hospital have no responsibility to ensure that your insurance claim is filed in a timely manner. They bill you whether you or they get reimbursed by insurance, or not. The insurance company is more than happy not to pay you any way they can. Sorry if this is harsh, but it's up to you to follow through.

See also here.

edited Feb 01 '11 at 15:22

Chris W. Rea

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answered Feb 01 '11 at 04:29

mbhunter

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score 4 · Answer 4 · edited Mar 13 '13 at 13:41

4

The hospital likely has a contract with your insurance company which makes them obligated to bill the insurance before billing you! I had a similar occurrence that was thrown out when my insurance company provided a copy of a contract with the hospital to the judge. So if there is an agreement they must file with the insurance in timely manner.

edited Mar 13 '13 at 13:41

Chris W. Rea

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answered Mar 13 '13 at 03:10

user9511

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score 2 · Answer 5 · answered Feb 02 '11 at 04:41

I had a similar issue take place at a hospital when the repeatedly billed the "wrong me" -- a stale insurance record left behind from when I was a dependent on my parent's insurance a decade earlier. They ended up billing me for anesthesia when I had a major surgery (everything else was billed to the correct insurance.)

The outsourced billing people were pretty unhelpful (not usually the case with hospitals), so I became the squeaky wheel. I sent certified letters, had my priest rattle the cage (it was a Catholic hospital) and eventually talked myself into a meeting with the VP of Finance, who started paying attention when the incompetence of his folks became apparent. Total cost: $0 + my time.

score 1 · Answer 6 · answered Feb 01 '11 at 04:25

That is your bill because the services were performed for you.

You still can negotiate with the doctor however. Suggest that while you aren't willing to pay the full share, you will pay the negotiated amount he would have actually gotten from the insurance company (or some fraction thereof). Doc did make a mistake, but you are very much liable for it.

score 1 · Answer 7 · answered Feb 01 '11 at 05:19

Here's my thought - call the insurance company back. Ask them to just tell you what the "reasonable and customary" approved payment would be. Offer that exact amount to the hospital, it's what they would have gotten anyway, and you learned a cheap lesson.

score 0 · Answer 8 · answered Feb 01 '11 at 14:22

If you read all that paperwork they made you fill out at the emergency room, there is probably something in there explicitly stating that you owe any bills you rack up regardless of what happens with the insurance company. They generally have a disclaimer that filing for you with your insurance company is a courtesy service they offer, but they are not obliged to do it.

Ultimately, you are responsible for your bills even if the provider slow-billed you.

Sorry.

The doctor didn't charge the health insurance in time, am I liable?

8 Answers8