Hospital did not submit claim to insurance until after the filing limit. Am I responsible?
Asked by
Susanb (
2
)
April 1st, 2010
Hello, a year and a half ago i had major surgery. Three months ago i received a call from the hospital looking for payment on an outstanding bill. I informed the caller that all hospital bills were paid in full. He looked through the paper work and realized that the hospital never sent me a bill for the physicians – I had no idea that the physician’s fees were not included in the overall hospital bill. The insurance will not pay two of the physicians bills as the claims were filed ‘beyond the plan’s filing limit’. My question is am I responsible for the charges in full do to the hospitals failure to file a claim?
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8 Answers
You should seek professional legal help with this question.
Based on what you said, no, you are not responsible.
It depends on your state laws. Most bills have to be submitted in a timely manner to be paid. Talk to a legal professional to see how long that is.
I agree with @ben.-Rarebear-drew
Find a lawyer. I would say that you are not the one responsible if you got your paperwork in on a timely manner- i.e. before the deadline and before any hospital made deadlines. Then again, I am not a lawyer and this sounds like you need professional advice on the situation and in pursuing legal action.
If you don’t think you can afford a lawyer, search. There are many lawyers out there who will offer advice and not take payment unless and until they win a case. Good luck.
You should contact your health insurance company and ask if you are liable. If the hospital is a contracted provider with your HMO then typically you would not be liable. Its common ptactice that when an hmo contracts fully with a hospital or provider there is language im the contracts that prohibit them from billing a member for denied services or unpaid contractual rates – members should only pay contract co-pay or coinsurance/ deductible amounts.
If the hospital is not affiliated with ur HMO then you may be on the hook but unlikely if the dr. passed the claim filing deadline.
Talk to your insurance company first and find out the providers participating status with them. If they are let them know what is happening and have them contact the provider. Otjerwise go with the legal advice.
screw that hospital. because they’re incompetent why should they be rewarded?
You are responsible for debts that you incur. Having a major operation and not expecting that you would have to pay for both the surgery and the hospital stay is a little naive. I really doubt that you can use the hospital accounts system as an excuse unless you can get a statement in writing admitting that they did not bill you. Even then, it might not work as there is an expectation that you should have followed up without prompting.
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