Health insurance problems?

Question

Here is my problem... My wife recieved chiropractic care 2 and a half years ago. The doctors had said her insurance covered her in full. Now, they are claiming we owe them over $4900 for the care she recieved. We called our insurance company and they said they didn't cover it because they submitted the claims 2 and a half years later which is too late. Should we be held responsible for their negligence and if not, what recourse would anyone here suggest. Thank you.

First, I would like to thank those that had answered so far. I would like to further mention that when my wife went to the doctors, she had cleared it with their billing department. They (the doctors billing department) had told her that everything was taken care of and that she owed nothing. Having been told that, I shouldn't have to call that billing department to ensure they sent in their claims. It is not my job to ensure they do theirs. I don't blame my insurance company in the least bit. However, I do not think that I have to suffer for my doctor's negligence in not submitting claims in a timely manner.ESPECIALLY 2 and a half years later.

In particular to mbrkatz17, I know that insurance companies do not pay the full amount to the provider. If the provider has no liability whatsoever about sending their claims in in a timely manner, then doctors are better off in not sending in claims and just start garnishing wages to collect 100 percent of their claims. I also just talked to my insurance company and said they broke the terms of their contract and are not entitiled to monies from us or the insurance company. Anyways, I'm not too worried... I'll just lawyer up. Thanks for all of your help.

Answer 1

Okay, what you should do is call your insurance company and get proof of when the claims were filed. Most of the time, on the EOBs when they're denied for timely filing, it says right on them: PATIENT NOT RESPONSIBLE. It's not a secret to the providers what their timely filing limit is - if they don't know it, it's their responsibilty to call and find out. As long as they are participating providers, the burden of proof is on them, and unless your insurance company tells otherwise (in writing!) - tell the provider to pack salt. They've gotta write it off as a loss. If they continue to bill you, call your insurance company and complain - they'll call the provider and tell them to pack salt.

Answer 2

I read your question twice before answering, and I don't claim to know much. But you say that the insurance company has a difference of opinion with the doctor. I would let both know that it is between the two of them to work out. The reason I say this is because the doctor DID wait 2 1/2 years to file, which is a ridiculously long time. If he had filed within the month of your first visit, then you would at least have known the status of whether it was covered or not. And then you could have decided whether to continue the therapy or not.
You acted in good faith that your doctor would file the claims in a timely manner. But the doctor didn't, and that seems to me to be the doctor's problem now.
The doctor will now be billing you for the work done, but I think that you have a reasonable case of being responsible in this manner, and if it goes to court, then I would make sure you are judged by a jury of your peers who would most likely rule in your favor. I certainly would if I were on the jury....if all you have said is the only pertinent information.
It's kind of weird, since it's usually the insurance companies who are at fault in trying to screw people.

Answer 3

Ok, I have a completely different take on this...Many carriers have what is called a balanced billing clause in their contracts..This balanced billing clause protects the insured from providers who are not satisified with the carrier's payments to bill the balance back to the insured.

I would do 3 things.

Immediately contact the insurer and ask them for something in writing on how the claim was filed in error. Meet with the chiropractors office, show them the report from the carrier.
Let them take you to collections if necessary, JUST MAKE SURE that you dispute the amount with the information obtained from the carrier.

I would also fight the carrier on this, contact your state's department of insurance, and file a complaint...

You may also want to make life more uncomfortable for the other parties involved by filing claims with the Better Business bureau, send your story to local television investigative reporters, ECT.

However, many people would disagree with me, but I think you just need to stick to your guns....Why should you be out $5k because some idiot in a doctors office does not know how to bill a claim....The insurance company should have paid the claim when they became aware of the problem. So why is this your problem?????

Answer 4

If they were a contracted provider at the time of service then you WOULD NOT be responsible to pay a claim if it was denied for untimely filing. Timely filing is part of the contract between the provider and insurance company which means they are contractually obligated to file claims with the insurance company in a timely manner. Therefore, if they submit a bill past the timely filing deadline, they CANNOT hold the patient responsible. They have to eat it. That should hold up in court (if it even goes that far). I would call and make sure they were contracted on the date of service, if not, you would be responsible for the bill. If they were contracted, contact the office and let them know that if they want to dispute this, they are going to need to do so with the insurance company, not you.

Answer 5

Yes. Regardless of who billed what when, YOU are responsible for payment of services received. Most claims DO have to be submitted within 6 months, and yes, it's up to YOU to be sure they are submitted, not the provider. Providers bill insurance companies as a COURTESY - there's no "guarantee" there that they'll do it in a timely manner.

The negligence is on your part, actually - you didn't check to see that they submitted the claim, and you didn't submit the claim, either, withint the proper time period. Sure, you "didn't know". But now you do.

There's no recourse for you. The chiro will take you to court for non-payment of the bills, and win. They can garnish your wages and attach your assets.

Answer 6

If the insurance company did not pay the bill because the doctor's office did not submit it in a timely fashion, you should not be responsible. Talk to the office manager, if you don't get satisfaction, it might be in your best interest to contact an attorney.

Answer 7

You ever been to a county wellness middle? you will possibly die interior the waiting room in the previous you have been seen. a lot of human beings are the working undesirable why could all people ought to % between drugs or nutrition for there kinfolk. Ive been in that place in the previous. I even have worked difficult to alter my problem. County hospitals are crammed with overworked drained team and staph infections. to no longer point out the attitudes from the staff besides by way of fact the waiting ill. I even have been blessed to have a staggering income given activity yet there are a brilliant form of jobs the do no longer grant medical advantages. I accept as true with wellness care reform besides as widespread wellness care. in case you have by no skill been undesirable or too uppity to undergo in techniques it then you definately does not agree.

Answer 8

you need to go to the office and sit down in person with the biller
IF they just billed for the 1st time?
its too late for them to collect from your insurance or you
It would be their loss