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Do I really have to pay this old medical bill? Consumer Q&A

By on July 20th, 2012
Filed: Advice, Consumers, Health Insurance, You

It’s been almost twenty years since I graduated from college but I still have a recurring nightmare: it’s the end of the semester and I suddenly realize I’m required to take a final exam for a class I attended maybe once, months ago, and had forgotten all about. !@#&!

Overlooking things can cost you. This is true when it comes to health insurance too. For example, last week on Yahoo Answers we took a question from someone who’s facing a year-old medical bill that he thought was already taken care of.

He’d been in a car accident and the bill had been processed by the auto insurance company first. He assumed the doctor’s office had forwarded the rest of the bill to his health insurance company. They didn’t, and when they finally discovered the oversight and submitted it, the insurance company said too much time had passed and they wouldn’t pay it.

Now the doctor’s office is billing him directly. Should he take it to court? What are his options?

The eHealthInsurance reply was voted Best Answer:

Generally speaking, in the end it’s considered the patient’s responsibility to make sure that all medical bills are submitted to the health insurance company for reimbursement. However, the process is complicated and largely in the hands of medical providers, so things like this can happen. When they do happen, it stinks.

To summarize the problem as I understand it, the auto insurer paid a portion of your medical bill. The remainder should have been submitted to your health insurance company, but the medical provider was slow to do so. When they finally did, the claim was denied because it wasn’t submitted in a timely manner. Now the doctor’s office is billing you for what was really their oversight.

Here’s what I’d recommend:

First, contact your health insurance provider, explain the situation step by step, and ask if they will make an exception and process the claim despite the fact that it was late. They may be more inclined to do so if you – rather than the doctor’s office – ask them to.

If they won’t process the claim when resubmitted by the doctor’s office, ask them if you can pay the bill to the doctor’s office and then submit the claim to your insurer yourself. They may be willing to reimburse you directly.

Finally – ask your insurer if the doctor’s office is in-network and, if so, if they’re contractually allowed to bill you like this. If they’re an in-network provider, they may have been contractually obligated to submit the bill for you in a timely manner. If they failed to do so, they may be contractually obligated NOT to bill you for it, but just to eat the loss.

If none of these options works, well, then I’m afraid I can only recommend that you pay the bill yourself. Otherwise, you’ll likely get sent to collections, it could affect your credit, and it would probably be more trouble taking it to court than it’s worth. In the end, if the doctor’s office isn’t contractually prevented from billing you for a claim they were late to submit, the charge likely becomes your responsibility by law, since services were rendered to you.

Best wishes.

Image by Flickr user DorkyMum

About Douglas Dalrymple

Doug Dalrymple is a member of the communications team at eHealth, Inc. and has worked in the health insurance and technology industries for fifteen years. He works on communications strategy, content creation and management, project management, and corporate messaging.

3 Comments Add Your Comment

Leslie on Tuesday, August 28 @ 10:19 pm

I would check your Statue of Limitations for your state, for my state it is only 3 years they can collect on a debt., others may be up to 7.5 years.
If it has been posted to your credit, dispute it with the credit bureaus, this will begin a process that may get the bill paid properly.

Paul on Saturday, March 15 @ 2:13 pm

So let me get this straight… You’re saying that a medical provider is able to not bill the payor and instead sit on their hands for a year and a half and then bill the patient? Lots of luck getting that to fly in court if you’re the doctor’s office.

Good thing for you the people who rate Yahoo Answers are not people who know the law.

Dennis on Wednesday, May 7 @ 12:48 pm

I had a similar situation arise.

My biggest concern is this –

If they had submitted to insurance, there would have been a sizable discount (at least 50% based on similar statements I’ve seen).

And yet, by waiting to bill me, they want me to pay the full list price of the service.

At a minimum, I believe the insurance company should calculate what the discount should have been so that I’m not on the hook for the list price.

I’m currently in my second appeal (first appeal was denied because it wasn’t within 180 days), this appeal is looking to determine what the discount should be.

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