Insurance question

[nia]

I had my surgery at the end of 2003, and stayed in rehab through Jan. 2004. By the summer of 2004, I thought all the hospital bills were taken care of. A few days ago, I received two explanations of benefits that said claims from these two doctors have been denied because they were filed too late. The claims were filed for some stomach issues I had during the rehab period in 2004, so I can see how filing for that is too late now. I don?t know why those claims weren?t filed earlier; the hospital had my insurance info all that time, and all others (or so I thought?) had billed me and were paid for by August of that year.

Since I have not yet received actual bills from them, it?s probably not a good idea to freak out now, but I can?t help it. Am I responsible for 100% of the cost when the reason for the denial of the claims seems to lie with them? Was there anything I should have done last year so that this situation could have been avoided? As always, thank you very much for your input.

 

[geebee]

A few things come to mind. One, can the insurance company actually refuse to pay a bill because too much time has passed? I am not really sure that is correct (although I could be wrong).

Two, does the EOB from the insurance company indicate patient responsibility? If not, that could be to your benefit.

Three, if there really is a statute of limitations on billing insurance companies, then there should be a statute of limitations on billing you also. However, the hospital may still try to collect thinking you may not know what is legal.

If you get a bill from the hospital, deal with it then. Until then, don't make yourself upset over it. If you do get a bill, I would ask your attorney the questions.

 

[Peggy in Alaska]

My son saw a provider in 2004. The provider billed the primary insurance directly, and they paid their benefit. Then, provider billed the secondary and for some reason, secondary was slow to pay. Provider sent a bill to my son and foolishly he paid it! So, provider has been paid, and I have been hassling with secondary for months now to get them to pay so I can get my son's money back!

The last EOB said the provider did not timely file the claim with the secondary ins. company, so they are not going to pay and it specifically says "We cannot cover services that were not submitted within your provider's contractual timely filing limitation. Due to provider's contractual agreement with us, you are not responsible for these charges." So I called the provider and said, refund my son's money. So now the provider is trying to provide enough information to the ins. carrier to prove they did timely file their claim. Evidently the contract for the preferred provider says you must file your claim within 150 days of the date of service, or claim will be denied.

So now I sit back and let them fight it out, but if I get another EOB that says it was not submitted timely, then I am going to demand my son's payment back.

So to make a long story short, if the provider submitted a claim too late, you should not have to pay. The provider is just out of luck.

 

[Blanche]

nia:
Most insurance companies have a deadline for claim submission. Our insurance allows 1 year. We were billed for two procedures two years after one of my husband's hospitalizations. I had copies of the denials from our insurance company. I called the billing service for the doctor involved, but they were not accommodating at first. Actually, they were quite rude. I enlisted the help of our insurance claims people, and I personally called the doctor's office (he was a hospitalist). The hospitalist's office person gave me the number for the owner of the billing service. She also put in a call to them on our behalf. Finally, they agreed to write-off the two bills.

I don't think that they can hold you accountable because they were not timely in processing your claim. But, I do suspect that you will have to go through quite a lot to get them agree to writing-off your bills. I wish you the very best in this endeavour. It can be a real pain. If you think I can be of any help, let me know.

Regards,
Blanche

 

[Guest]

Is there anything you could have done?

Nope ... that's not your job to make sure the claims are submitted on time. That is the provider's responsibility.

And, yes, I would forget about it until you receive a bill from the provider. If you do get a bill, don't freak out ... call the provider/insurance company _after_ the "shock" has worn off ... you don't want to be calling a company when you yourself are "explosive" ... calls made then can easily escalate with tempers out of whack.....


Cort, "Mr MC" / "Mr Road Trip", 32swm/pig valve/pacemaker
MC:family.IL.guide.future = http://www.chevyasylum.com/cort/
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"There's so much I need to say to you" ... Phil Collins ... 'Take A Look At Me Now / Against All Odds'

 

[Cris N]

Maybe the solution to avoiding future problems is getting the provider to sign a "disclosure" form from the patient stating that they will bill insurance co. on a timely basis. If not, they agree to not get paid! It's time to make them sign some responsibility documents instead of making the patient sign the same "$%*&" form every time you walk through the door.

The thing that gets me is the double billing from the provider to ins. co. My insurance is basically 100% coverage. Twice I've caught providers double billing. I've called the insurance co and they tell me to call the provider. So I call the provider and after they realize they've been caught ("oh, I'm sorry, we must have made a mistake" - yeah, right ) they say they'll 'take care of it" Oh, they take care of it alright - all the way to the bank - 2 weeks later I see the processed payment (with check no. ) at the ins co online site. Grrrr... no wonder premiums are so high.

Cris

 

[nia]

Thank you

Thank you

Thank you so much everyone for your comments. I just flipped out when I got the EOBs because I was already having issues with school tuition due to the school?s screw-up of scholarship renewal, and also had some minor health woes, and then today, my dorm room flooded at 8:30am, which is pretty early for me? (It?s a funny story now, but when the facilities management person came and laughed about it in the morning, it sure wasn?t so funny.) And I guess what made things harder was that people around me can?t really help me as ultimately I?m the one who needs to deal with it, even though they really are great about listening, and I?m reluctant to tell my parents about these things for several reasons. I?m really sorry to complain; I know these things are minor compared to the problems that many of the people on this board are going though.

I sincerely appreciated all of your messages. I?ll stop worrying about it, but will call the insurance company on Monday to gather what information they can give me. Fortunately, my insurance is through school, and their representatives are generally nice to undergraduate students. I?ve never had issues with them, though I?ve had problematic providers who just wouldn?t file claims and instead kept charging me (and even said they?d use some collection agency if I didn?t pay). I?ve dealt with them successfully, and I?m just hoping that, should these doctors actually bill me, they?d do it soon so that I can deal with them while still in school and thus have direct access to the same insurance company that I used during the hospitalization.

The on-line policy says that the claim must be filed within 90 days of treatment. EOBs indicate they filed the claim last week for something done in January of 2004. Talk about being waaaay overdue. Since I was treated at the university-affiliated facility which is the first place the students get sent to, I really don?t see how they couldn?t have known about the claim deadline.

Gina: it says that the doctor ?may? bill me the uncovered amount. If they bill me, then I?ll find out if the hospital had some due date for billing also. Thank you for the tip.

Peggy: Unfortunately, my EOB doesn?t say that I?m not responsible for this, but then it doesn?t say that I am either, so I guess I should just wait and see. Hope your son?s insurance issue can get straightened out soon too.

Blanche: Thank you for offering to help me. It?s really encouraging to know that there are people who?ve had the same problem and settled it successfully, though actually, no one should have to go through these things.

Cort: Yes, I will use this weekend to calm myself? I?ve learned from experience what I?m capable of saying when I am quite angry.

Cris: For some reason, my insurance company is really good about filtering out those double filers. I?ve seen a hospital billing the insurance for the bed and board fee twice?maybe that?s how the hospital managed to pay the rent/mortgage to stay on one of the most expensive parts of the city?

PamO: Thank you for the detailed advice. My school does have an insurance office, so I?ll contact them too. If the insurance company/providers thought I?d give up easily, they are picking the battle with the wrong person.

Again, thank you very much everyone. I will post if anything new comes up. I?ll just sit and relax for now and maybe do some homework for class. Midterms are just around the corner.

 

[Guest]

You are quite welcome ... I'm glad you are taking the weekend to "chill out" before starting the process .

 

[Glenda]

This happened to me a few years ago after one of my many surgeries. The hopital had to write it off because it was their fault.

 

[Georgia]

If you get hassled about this, contact the NY Dept. of Insurance - NY is a very consumer-friendly state and you'll get the help you need. This isn't to say that you're definitely off the hook on this (you would have been if this was an HMO), but at least you'll get the real skinny on who's responsible for this.