Are there any regulations about how much time after a doctor visit you can be billed?

Question

I went to the emergency room back in February. Shortly thereafter I received the bill which I submitted to my insurance company and it was all taken care of. However, in September I received a separate bill from the emergency room doctor for the same visit. When I submitted this to my insurance company they denied it because they said the timeframe for claim submission had expired. Now I feel I'm stuck.

The first bill was definitely taken care of. I think I had to contribute $50. This was done and I received a statement indicating that my portion and the insurance company's portion were received and the account was settled. The second bill indicated it was for the doctor's services only and this was in addition to any previously received emergency room bill (even though that was six months prior).

Answer 1

Have you spoken with the hospital to make sure this is not an error on their part? Have you confirmed the bill was paid by your insurance or did you just assume that it was "taken care of".

If the hospital billed your insurance company and they rejected the bill (happens sometimes - for things as simple as the bill was coded wrong) - then the bill goes back to the hospital - they correct and re-bill. The bill could have bounced around between the hospital and your insurance before finally being sent to you.

Start with the hospital billing department.

Answer 2

6 months isn't that long. Your insurance company may indeed have a timeframe of 90 days or something in which you must submit claims. After that, you are on yor own. Check w/ the insurance company. Call them and ask how long you have to submit a claim with out referencing your case. See what they say

Answer 3

Appeal the insurance company's decision. You should be able to get them to pay; if not go to the State Health Department or Department of Insurance.