Hospital didn’t submit to insurance in time

LBG10

I received an outstanding bill from A procedure I had over a year and a half ago, according to my Explanation of Benefits it was not submitted to insurance on time so Iam responsibile for the bill! How is this possible, the procedure was pre authorized thru my insurance and would have been covered/paid if the hospital would have submitted it in that claim year!

What can I do to fight this bill?

Any advice would be greatly appreciated

LBG10

Yogatyme

I am a retired provider and dealt w insurance issues for 37 yrs. It has always been my understanding that if I didn’t file the claim within a yr of date of service, the insurance co would deny and the provider COULD NOT bill the pt for it. This is their neglect and you have no control over their billing practices, so, their problem, not yours. I would encourage you to call your insurance co and discuss this w them. If your facility is “in network” the insurance co will deal w facility. If out of network, they are still likely to take on the facility. DO NOT pay that bill until you have minimally talked w insurance co. If you don’t get anywhere w that, contact your state insurance commissioner. As a provider, when I had problems w insurance co, commissioner was always helpful. I hope this helps.

MinusTwo

Yes - and you can also contact the provider and find out the details of when the claim was submitted and why. Did they use the wrong code? Did the insurance return it to the provider and it wasn't re-submittted?

Don't pay it until you do lots more research.

nopink2019

Your insurer's EOB states the problem - "time expired to file". I've have this almost every year. Don't pay it! Happens alot in Jan & Feb each year when acctg depts try to clear out their uncollected amounts. I've called several providers and told them that their billing dept problems are not mine. Some persist a little, but most recognize their error and quit bothering. You had insurance coverage, they accepted the card, not your problem. Some insurance co have shorter time frames than 1 yr, but, again, that is an issue for the provider's billing dept to understand when they choose to do business with them.

rockymountaingirl

Another vote here for "Don't pay it." If the provider submitted the claim late, it is the provider's problem and the provider's loss. They know there is a time limit for submitting claims. If the provider tries to get you to pay the bill after you have explained why you think you are not responsible for it, refuse, and see if your insurance company will help you out by telling the provider to back off. (I know insurance companies are often "the enemy", but they do represent you in dealings with providers, and they can be helpful sometimes in a situation like this.) If the provider persists, refer the matter to your state insurance commissioner and/or the agency in your state that deals with consumer protection issues. Remember that it is best to put your response to any attempt to collect the bill in writing, and keep copies of your letter and any other correspondence or documentation of the dispute. Good luck!

gb2115

I don't believe they can bill you for that. Call the insurance company. Also see if the hospital has a patient advocate, they might help.

cowgal

We had something similar happen. I called my insurance and they said they never received the bill from the provider but couldn't pay it because it was a yeast and a half old. I called the provider and it turns ther original bill was sent to the wrong insurance company and they had just notified the provider that I didn't have coverage with them. I did not have to pay.