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Doctor's bill received a year after treatment, insurance now won't cover

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by codester00, Jan 17, 2011.

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  1. codester00

    codester00 Law Topic Starter New Member

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    Hi,

    I recently received a bill from a doctor for treatment performed over 12 months ago. The treatment was not urgent and I was clear with the office staff I did not want the procedure unless my insurance would cover it. They told me they would file the paperwork but couldn't guarantee the insurance company would cover the procedure. I called the insurance company and they said it would be covered. So I got the procedure.

    Now I have this bill and the insurance company says there is nothing they can do because the treatment was so long ago, and the doctor's office won't accept any fault because they claim they file with insurance as a courtesy and it isn't their fault, and that I should have filed the claim myself.

    The insurance company says they would have paid it if it had been filed on time. Do I have any legal ground to stand on from the angle that they failed to file the paperwork or from the angle that they didn't bill me for over a year? Or maybe the insurance company still should have to pay it regardless of the length of time? If they can legally bill me that late, why can't they legally bill the insurance company that late?

    Thanks,

    Codester
     
    bluemann33 likes this.
  2. bluemann33

    bluemann33 New Member

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    I would call the insurance company back and ask to speak with the president if I had to (lol) I don't think a year is reason for the insurance company to deny payment. If I am wrong someone else will correct me but I odnt think I am. Like I said call insurance co. back, ask the Dr. to resend bill back. Insurance companies screw up all the time and with a little presure, usually get things straight. Good luck to you.
     
  3. codester00

    codester00 Law Topic Starter New Member

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    I forgot to add, this procedure was done just before I dropped off of my parents insurance. So that is a reason they won't pay because I'm not on the insurance anymore even though I was when the procedure was performed and it was supposed to be billed. I don't know if that changes things, but perhaps.
     
  4. mightymoose

    mightymoose Moderator

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    If you were covered at the time, and the bill was not paid by any fault of your own, then you are probably not on the hook. If you had any notice along the way that there was a problem and failed to take care of the matter then you could be responsible.

    This sounds like a bill that your doctor will have to eat. The doctor will demand payment from you because insurance refused it, but it was the doctor's responsibility to handle the claim in a timely manner. Don't be intimidated by their demands. The doctor's option is to either work it out with insurance or to settle the dispute in court. The only reason the doctor was not paid by insurance is because the doctor's staff failed to make the request timely or properly. Not your fault.

    Do nothing. If you are ever served papers and given notice that this is going to court THEN go speak with a local attorney to see how to proceed. In the mean time watch your credit report and make sure they don't make a negative claim against you. Dispute it if they do and protect your credit rating.
     
  5. mightymoose

    mightymoose Moderator

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    No, it doesn't. If you were covered at the time of the procedure then you are fine.
     

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