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jumpingfireants | I just received a letter from my health insurance company saying that I owe a doctor that I saw once $600+? |
I went there for a checkup and PAID my 40 dollar co-pay. This check up was done in November of 2006, and the letter from my health insurance company said that they would not cover the cost because the claim was filed/ received of November 2007- more than a year later!
This isn't my responsibility right, I paid my copay and that doctor's office was supposed to do the rest. How do I handle the situation? |
 |
 
sarah314
|
Sometimes insurance companies put into the doctor's contracts that they are required to write off charges if not timely filed. (I used to work for a medical provider negotiating contracts with insurance companies, and I've seen that provision in several.)
Not all contracts between insurance companies and doctor's offices have this provision. But, it would be wise to find out if your particular doctor's contract does.
What you need to ask:
1) Does your doctor have a contract with your insurance company? (If not, then you're pretty much stuck with the charges no matter what.)
2) If so, does your doctor's contract require that they bill within 12 months from the date of service or else write off the charges?
If the answer to question #2 is "yes," then you should not be billed for the charges. The provider should write them off. If you get a bill, contact your insurer immediately so that their contracting department can help resolve the issue.
If the answer to question #2 is "no," then you're pretty much stuck with the charges. The insurer isn't obligated to pay after 12 months. And the doctor is still entitled to their money...unfortunately, that leaves you holding the bag. |
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Hubris252
 |
You are correct. The insurance company was not telling you that you owe the doctor, only that they are not going to pay the doctor. If you get a bill from the doctor you will need to contact the insurance company and get something in writing stating that they would have paid if the claim had been filed within timely filing limits. This prevents the doctor's office from being able to come after you for the $600. Ultimately, don't even worry about it until you get a bill from the doctor's office. |
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acermill
|
The doctor's office may turn your account to collection for the amount owed. While the doctor's office was remiss in very tardy filing of the claim, you are still responsible for the charges incurred. Apparently you do not carefully monitor the assorted reports which you get from your insurance carrier when a claim is filed.
Your best bet is to appeal to the insurer for payment, based upon the failure to file timely by the physician. However, if they refuse (and they can), you are ultimately responsible for the charges incurred. |
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mbrcatz
|
Wrong, it's your responsibility to make sure that the doctor bills the insurance company - and if they don't, to get the claim form yourself, and send it in.
The doctor has NO obligation to bill the insurance company - they do it as a courtesy. Likely, it's too late now. You can call the doctor's office and ask them to waive the charges, as it was their fault that the insurance wasn't submitted in a timely basis. If they agree, great. If they don't, you're cooked. They'll turn it over to collections, who will take you to court, AND WIN. Then they'll garnish your wages to collect the original amount, plus legal fees and interest.
Sorry. It's up to you to babysit your health insurance carrier and the doctor, to be sure bills are submitted/paid. |
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Sue
|
Don't worry about it...you are only responsible if you did not provide your doctor with your insurance information in a timely manner.
I am going to assume you have either an HMO or a PPO policy since you have a copay. In this case, the provider (doctor) has an agreement with the insurance co. stating that claims must be filed within a specific time period (usually 90 days).
The claim did deny for timely filing, but if you look at your claim summary that you received, it likely states that your liability is $0.
The doctor can always appeal to the insurance...and if they have a good reason as to why they waited so long to submit the claim, the insurance will likely pay anyway. |
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