Can a doctor bill me over a year after my appointment?

Question

I last saw my doctor a year and a half ago... two weeks ago I received a note from my insurance informing me that they will not be paying or even reducing the charges on the bill from that visit (as they just received it) because it was not submitted within a reasonable time-frame. My question is -- if my doctor says he takes my insurance, isn't he under any kind of legal obligation to follow the rules of submitting the bills in a timely manner? If so, should I be responsible for paying this bill (which is over $300) after a year and a half and after my insurance has rejected it?

Do I have any legal grounds to protest this bill? Or if I protest will I end up having a bill collector on my butt?

Please advise!

Answer 1

If your doctor is in network, call your insurance company.  Most times, the contract between the provider and the insurance company specifies that if the in network provider doesn't bill in a timely manner, they (the provider) has to eat the charges, and cannot bill YOU for it.  

If the contract doesn't state that, though, then yes, the doctor can come after you for it.  You don't have any legal grounds to protest this bill.  But your insurance company can protest it on your behalf, due to their contract info - if it applies.

Answer 2

MSAD has obviously never dealt with insurance contracts - every single one of them has a timely filing provision.

The industry standard used to be 12 months from the date of service, but some companies are even moving to shorter time frames.  We work with several insurers who won't accept claims more than 180 days from the date of service.

If the provider is contracted with your insurance company, most likely they are obligated to write off the charge.  Check with your insurer and/or refer to your Explanation of Benefits to be sure.  **However** if your doctor was unable to file the claim within 12 months because of a delay on your behalf...say, because you didn't provide the doctor with complete and/or accurate insurance information...then the doctor may still be able to bill you anyhow.

I would definitely call your insurer and ask whether you should be getting billed by the doctor - if the charges are something that the doctor should write off, then your insurer should be able to tell you that and possibly send a notice to the provider reminding him that he shouldn't be billing you.

Answer 3

yessir he can. i know its rediculous but theres nothing you can do

Answer 4

The legal answer that they will give you is that it is YOUR responsibility to make sure the bills are submitted to the insurance company in a timely manner.  The doctor's office does it as a courtesy but they are not obligated to do so.  They will tell you that you should have noticed that you did not have a claim pending with your insurance company and never received an explanation of benefits.

It's a way for the insurance co to deny paying but it's the legal truth.

Have you contacted the doctor about the bill to find out why it was submitted so late?  If the insurance company won't pay due to the late filing, I'd try and make the doctor take responsibility for the charges.  I'd approach the office and offer to pay whatever your portion of the bill would have been (co-pay, % of total, etc) and tell them you consider it paid in full.  If they want to collect more, they should have either billed the insurance company or you more timely.

It seems odd that a doctor's office would let a bill age that long without following up on it.  If they weren't getting money from the insurance co, they should have tried to bill you.  If they didn't bill you in a year and a half either, something is really bad with their bookkeeping system.

But don't let it go to collections.  Work with them to get it resolved and get it in writing so it doesn't bite you later.  It will be much less expensive for everyone for the doctor's office to accept whatever money you are offering and be done with it.

Answer 5

You got the treatment--- the bill is yours to deal with.

Have you considered calling your health insurance and going off on them?

Have them send you something in writing that says they do not have to pay any covered services just because the dr billed it a year after the service was rendered.   That is about the stupidest reason for a denial I've heard in a long time. I don't think that's a valid claim denial.

If you had a valid insurance policy and a covered service was rendered by a covered provider....they owe the charges.  The statute of limitations that would apply would be the one for contracts. In my state--- that's 7 years.

I'd want to see the provision in the health insurance contract that says being billed 1.5 years after the date of service is grounds for a denial.

Usually if you raise a stink on the health ins they pay for it.  I have to go off on mine just about every time I use it.

If that does not work--- file a complaint with your states Insurance Department and send them copies of the written documents you got from the health ins co.  The insurance dept  regulates all types of insurance that does business in your state.