Bill From Doctor's Office saying insurance refused to pay due to 'untimely billing by office'?

Question

My wife got a bill from our doctor's office from July 2006 that states 'insurance has denied these services for timely filing'. 'We have submitted proof of timely filing $ they still have not processed the claim. You owe us $85.00'

Obviously we had nothing to do with the paperwork or the bureaucracy of the problem. Why would we been on the hook for the money when it is the office that didn't follow through on their end?

If i purchased an item via credit card and the merchant refused to run the card for 1 year would I still be responsible for that charge as well?

Answer 1

Call your insurance company ASAP. If you provided the insurance info to the doctor's office at the time of service, and they didn't file the claim on time, they have to eat the bill. When a claim is denied for timely filing, it states clearly on the EOB (explanation of benefits) that the patient CAN NOT be billed and they are NOT responsible - and the doctor's office has to eat the bill. Every doctor's office knows their timely filing limit (it ranges from 30 days to a year from the time of service, with 90 days being most common) - it's not a secret!

Call your insurance company and confirm that timely filing was the reason for denial and then ask them to call the doctor's office to tell them that you are not responsible for the bill. Most insurance companies will do that for you, but if they don't or can't call the office yourself and tell them that your insurance company rules state that if the provider drops the ball on filing, you can not be billed and the charges are supposed to be written off. (If they refuse to write them off, call your insurance and file a complaint. If a practice has enough complaints, they can lose their credentialing.)

Now, if you didn't give them your insurance info until six months after the visit, you ARE responsible - they tried to file with your plan as a courtesy.

Answer 2

Not illegal- The fact is that a Providers office is a business. The Doctor provides you with a service that is not free. The billing department and or the scheduling department have already checked your benefits before you even come in. The copay, the coins, the deductible, and the out of pocket maximum. They have also check to see how much of that deductible and out of pocket you have met or have not met. That's how it is know what you still owe. When an office has a contract with your insurance company, this simply means that they have come to an agreement on how much a service will be allowed at. Example: Dr A charges $2000 for a Vas, however Dr A signed a contract with BCBS to accept only $1000 for it for people who carry that insurance. That is all it means. Dr A has every right to collect that $1000 upfront from the patient, because it was confirmed by the insurance company that the patient had not met their $1000 deduct yet. Lets say the patient has met $500 of the $1000 deductible then Dr A should only collect $500 upfront from the patient as the insurance has already agreed to pay the rest once the deductible has been met.

Answer 3

Unless the office guaranteed to be responsible for submitting the insurance documentation - which is EXTREMELY unusual, you are ALWAYS responsible, ultimately, for services rendered.

You should have received a letter from the insurance company directly, an explanation of benefits, denying the coverage, with the reason for denial.

You SHOULD have had something to do with the paperwork. You should have been following up with the insurance company. I know, no one ever told you.

All you can do is APPEAL the decision with the insurance company. Call them, ask when they received the claimr equest. ASk the doctor when they sent it, and what the "proof of timely filing" is. Maybe the insurance company messed up, maybe the doctor's office messed up. If it's the insurance company, an appeal should fix the situation - but you need the documentation from the doctor's office to proof that the bill was filed in a timely manner.

Answer 4

If the doctor's office is participating with your insurance, their contract prohibits them from billing you in this instance. Call your insurance company. Tell them you're being billed by the doctor. The customer service person should be able to assist you with this bill. The doctor's office should either appeal or write off the charge. good luck

Answer 5

Claims denied for untimely file are adjusted off, the real question should be can you be charged the coinsurance amount. Charges are normally adjusted showing the insurance liability, the patient liability and the contractual write.

Answer 6

~~If you have health insurance through your employer, take the paperwork to your personel/human resorce officer. They should always have access to the employers health insurance rep. They will contact the health insurance rep and it should be taken care of that way. Any time there is a condradiction regarding bills/health insurance, this is the route to go.

Answer 7

I think you need to talk with the doctor's office to try to clear up the situation. If necessary, ask to speak directly with the doctor. It's his business, and he's the boss. A mistake on their end should not be your problem.