How long does a doctor have to file an insurance claim?

Question

I posted a similar question yesterday, but left out some details...

I had surgery 7 months ago. I got the claim from the insurance company and owed nothing.

Well, I did not happen to notice that "Anesthesia" was not listed on the claim.

Then yesterday I got a bill in the mail for hundreds of dollars from the doctor's office for "Anesthesia".

My insurance covers anesthesia during surgery 100%.

It seems as if the doctor's office forgot to send the claim in to insurance in a timely fashion and has decided to just bill me instead.

I am pissed!

Is this legitimate?

Answer 1

Various insurance companies have their own rules.  My plan, which is with a major insurer, gives the doctors a full year to come up with their bill!  It's not bad enough that you get the huge EOBs you were expecting, but other bills which are indecipherable keep trickling in.  I was on the phone for what seemed like weeks after one ER visit last year.  The doctor is not obligated to file with your insurance company, but he does so as a courtesy to you.  It is good that you are staying on top of this, because you are responsible for the bill if anything is missed, coded wrong, etc.

Answer 2

It varies with the insurer.  You should immediately contact the anesthesiologist and instruct them to fill with your insurance.  In writing, certified mail.

Answer 3

Have you contacted the doctor's office to make sure they have your correct insurance information?

If they don't have the correct insurance information on file for you, then they can't file a claim.  So, generally the provider's office will send the bill to you hoping that it gets you to call the office.  (On average, patients don't tend to return phone calls asking for insurance information.  So, its pretty standard to just mail a bill...it gets their attention.)

You need to find out what the claims filing limit is for your insurance policy...it can range anywhere from 6 months to a year, generally.

If you're still within the filing limit, then you need to make sure the doctor's office has what they need to file the claim.

If its past the filing limit, a doctor who has a contract with your insurer will usually have to write off the bill (unless they can prove that the patient was at fault for not providing accurate insurance info).  If the doctor does not have a contract with your insurance company, there's nothing stopping them from billing you for the entire service.

But you definitely need to call the doctor's office and your insurance company to confirm exactly what the issue is here.

Answer 4

Yes, it's legitimate.  

Most insurance companies require that a claim be filed within six months, in order to get it paid.

At the same time, most contracts with "in network" providers, state that if the provider fails to bill the carrier, within the allotted time, they're not allowed to bill the patient.

I have no idea, though, how you'd get that to hold up in court.  I think you need to call your insurance company, to see if that's part of the claim.