Can anyone help with with a medical bill that I received?

About 9 1/2 months ago, I went to an Ear Nose and Throat doctor in regards to water behind my eardrum issue that I was having. When I went to the doctor, on 08/13/09, the office told me that they would let me know how much my office visit would be. Today, on 05/29/10, I received my first bill stating that I wasn't covered under insurance. Besides the fact that I know that I was covered under health insurance at the time, I don't have health insurance anymore. Do I have any recourse against the doctor's office since they are contacting me over 9 months after the fact for the very first time? If it helps, I live in Florida;

No recourse, you unfortunately have to pay your bill as far as the doctor is concerned. Try speaking to a rep at your insurance company in the early morning hours to see if the coverage issue was/is a mistake. Good luck.

No, and it's sad that you think so. You saw the doctor and must pay...9 months or not. The debt doesn't expire. If you were covered at the time submit it to your insurance.

If you had insurance at the time, I would think that they should cover it. If you don't have it now, though, then they really can't unless you reapply. I think morally they should cover you, but they probably won't.

BTW, I know this isn't useful, but 8/13/09 is the 25th anniversary of the date of a Weird Al Yankovic concert bootleg I have.

They always send outstanding bills to a billing agency and it took this long to catch up with you I think. Even if you told the doctor's office the procedure was covered, and it turned out not to be covered, it is your responsibility to know that and you are liable for the bill. You cannot expect the doctor to know if that procedure is covered. You would have called your insurance company to ask before going to the doctor. If you think you were covered contact the insurance company and ask why they did not pay it.

You should have followed up with the provider LONG before this. If you had insurance coverage in effect at the time, take that documentation to the provider and have a "frank discussion" about their insurance billing failures. WHY are they saying you were not covered? They can still file an insurance claim.

If the doctor lied, yes. If the insurance company made a mistake, then you have no recourse against the doctor, but you do have recourse against the insurance company.

You are goiing to have to contact the health ins company that covered you at the time of service and ask them why your claim was rejected.

Some specialists are very slow to send out bills.

If they billed the insurance company you would have received an Explanation Of Benefits (EOB) from the insurance company. AND, if you weren't covered at the time then the insurance company would note that on the EOB. Call the insurance company you had at the time and ask about the claim.

Seems like gross negligence on your Dr's part. Something fishy here. Maybe they were paid by the insurance company, and are trying to get paid by you as well. Maybe they applied the payment from the insurance company to the wrong patient. Or maybe the diagnosis / procedure wasn't covered in your plan, or was mis-coded to the insurance company. Or maybe your insurance company made an incorrect judgment call. All are possibilities.

If you had insurance the day the procedure was done, the insurance company still has an obligation to review the bill for payment. Make a copy of the bill from your doctor, send that copy to the insurance company you had at the time. Explain the situation, and the procedure that was done. Ask them if they received the filing from the Dr;s office, and if so, ask them what was their decision on the bill (they being the insurance company), and the reasoning for the decision if it was rejected. You will get a letter from the insurance company explaining the outcome, or, maybe to your surprise, a check. (an insurance company doesn't necessarily have to pay a Dr. directly, they can pay you, and it would be up to you to pay the Dr.).

It could also be that you have a very large deductible with the insurance company that wasn't met. But in any case, if the Dr's office DID indeed file a claim, you should have heard back from your insurance company, usually within 30-60 days.

To be fair to the Dr though, some insurance companies are NOTORIOUS for dragging out claims. The insurance company I have here in FL usually pays within 30 days, but I have heard of others in different states where the Dr has waited over 6 months. That's just not right!

Call your insurance company, see if they can work it out over the phone. If they can't, send a copy of the bill and a letter to them, certified mail, return receipt requested, asking them to put in writing their decision. Also, if the insurance company is hard to deal with, and this is very important, write down the dates, times, names, nature, and durations of the calls you make with the insurance company. You want a record if you want to pursue this further (arbitration or court), and you'll be surprised at just how much a company can change their tune when you start reading off names and dates.

Good luck!

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