Insurance won't pay medical bills because they're filed too late

[emubird]

We just got a note from our health insurance company that they aren't going to pay over 5000 dollars in medical bills because they were filed too late by the medical provider asking for the money.

 

Does anyone know if this now means that we're going to be responsible for paying them, in the eyes of the medical provider (and the law)? And, if so, how in the world do we avoid paying a thing that the insurance was supposed to pay for?

 

Do we contact the medical provider to let them know we aren't going to be paying this? Or do we lay low and let them sort it out, only going into action if they have the nerve to bill us?

 

Any advice?

[edithcrawley]

I would contact the medical provider and explain the problem. They should know the cut-off dates for insurance, it is their fault if they didn't get the paperwork in on time.

[Nestof3]

First, you need to see if you are the one who is supposed to file the paperwork or if the provider is. Then you need to see if your policy has a clause that says whoever is responsible to file, the ultimate responsibility to make sure it is filed falls on the customer.

 

Finally, you need to look at your policy and see if there is a time cut-off for filing and what the policy says the consequence is.

 

It should all be there in the policy.

[freethinkermama]

We just got a note from our health insurance company that they aren't going to pay over 5000 dollars in medical bills because they were filed too late by the medical provider asking for the money.

 

Does anyone know if this now means that we're going to be responsible for paying them, in the eyes of the medical provider (and the law)? And, if so, how in the world do we avoid paying a thing that the insurance was supposed to pay for?

 

Do we contact the medical provider to let them know we aren't going to be paying this? Or do we lay low and let them sort it out, only going into action if they have the nerve to bill us?

 

Any advice?

 

Who was supposed to file with the insurance? This happened about a year ago with my parents. My father was hospitalized, and the hospital didn't file for nearly a year afterward. Oops! Hospital had to eat the whole thing because the cut-off date was a year afterward.

Track that down, but just so you know, you'll have a heck of a time getting anyone to talk to you in billing at the hospital. Just keep calling and calling.

Luck!

[juelle]

Our dentist is working the same problem for us. The insurance co say it's too late because they demanded additional paperwork, then lost it in their system. Dh will hold them accountable because it's their mistake.

[mcconnellboys]

Yes, you contact the medical provider. If they don't file in a timely manner, then that's their problem to correct. You should not be responsible for their error.

[Joker]

We had this happen once to us and we didn't have to pay a dime. The insurance company told us it was the provider's fault and we were not obligated to do anything. The medical provider never asked us for payment.

[Pippen]

Who was supposed to file with the insurance? This happened about a year ago with my parents. My father was hospitalized, and the hospital didn't file for nearly a year afterward. Oops! Hospital had to eat the whole thing because the cut-off date was a year afterward.

Luck!

 

This happened to me with a promptcare visit. They started sending me bills and then threatened collections. The insurance company told me to tell them they'd passed the filing date in the contractual agreement but still they continued. Finally it took an insurance company representative to call and insist they stop--they got done in a few minutes (with me on hold) what I hadn't been able to accomplish on my own.

[kalanamak]

Who was supposed to file with the insurance? This happened about a year ago with my parents. My father was hospitalized, and the hospital didn't file for nearly a year afterward. Oops! Hospital had to eat the whole thing because the cut-off date was a year afterward.

 

 

This happened to me, and the hospital never tried to bill me for it. I didn't contact them, they didn't contact me. The only knowledge I had was the ins. company sending me a denial note. I kept mum, and nothing else happened. The hospital did go belly up and was bought out by a big chain shortly thereafter.

[Alyce]

One of the Dr I saw hated doing paperwork so he never sent the billing dept the bills until he left the business. What I don't understand is that you have to turn in a billing form when you check out. You'd think they would double check each other. Anyway. The insurance company declines about 5,000 worth of services that this Dr had done because the company the Dr worked for had waited so long to file. They never billed me and actually since the accouting agency had missed so many deadlines I actually ended up with a zero balance after $7,000 previously.

[KidsHappen]

This has happened the first two times my dd have got braces because our dentist doesn't submit the insurance until the work is complete but the insurance company considers the work being done when it started (which is usually two or three years before). I have always let the dentist and the insurance people work it out. I have one dd in braces right now and it seems as if they have changed the billing practice by breaking it down as a charge for each visit instead of the total amount at the end.

[Kari C in SC]

This happened to us with our dd's ankle surgery. A year after, we got a bill for $27,000.00. When I called and checked into it the hospital billing said that they had failed to bill within the year period, so they had to write it off. I never got another bill after that.

[newlifemom]

Same thing happened with me. Hosp. messed up Dd's 8 day stay. I was actually relieved. 10% of 30,000 is a lot! I never had to pay for their mistake or my co-insurance. Don't worry, I have had to overpay my old pediatrician's office so it all evens out. :glare:

[Renee in NC]

This happened to me and I *was* responsible for the bill, but I did not pay it (and WON'T!) The billing person (small hospital) was eventually fired, but when the insurance company refused to pay because it had been so long, they harassed me for months.

 

Their mistake made it so the radiologist and ambulance bill (to transfer my ds to another hospital) didn't get paid either.

[emubird]

Thanks for the encouragement! I have to say, that paying 5000 dollars that we shouldn't have to pay is really not the best thing for my husband's health right now, so it was good to hear others have been through this.