[tmart0123]

I had surgery last summer of 2006 and gave my insurance info the first Dr's office visit, I just recently got in the mail a bill totaling $7735.00 for the operation. I called the collection agency and said I have insurance and why was I getting a bill, come to find out the billing agency for my Dr didn't file the claim until 3/07 and the insurance co is refusing to pay stating "untimely filing", the insurance company says its my problem now. Never once did anybody in the last 9mo send me anything stating there was any problem. I called back the collection agency and they asked me to start a payment plan, I was so MAD and said no way am I paying this bill. Anybody have any ideas, I called the MD office and told them they would have to eat this bill, I am not responsible.

[ScottGem]

Who does the collection agency represent? Is it the hospital or the doctor? You are responsible for providing your insurance information to the hospital. Since this was, apparently, a scheduled procedure, you would have had to provide your insurance info on admission.

If it's the doctor, then you tell the doctor that you provided the info about your coverage and if their office screwed up the billing that's between them and the insurance carrier. Tell them to call off the collection agency.

[tmart0123]

The collection agency represents the MD, as for the scheduled procedure, my insurance states that any and all procedures done at this one particular hospital where it was done are always paid 100%, they paid the hospital portion of my stay overnight, its just the surgeon's billing office didn't file on time, is why I want to pull my hair out, I spoke to the MD office and they have "apologized" and she'll talk to her manager Monday, and get this fixed. They better, or they'll eat this bill. Thanks for your suggestions.

[Fr_Chuck]

Ok, first breathe and calm down, your doctor messed up, but there is a problem, one on all medical bills, you sign a contract or agreement stating that you will be responsible for the bill if the insurance company does not pay. So you doctor is doing what they have a legal right to do, bill you since they were not paid ( even if they were not paid for neglect on their part) Since because of the statue of limitation on the bill they can still collect from you.

You need to not talk to the collection, and not even the doctor at this pont, but you need to talk to the insurance company, start with your local agent ( and please say you have a local agent) but you most likely will have to sue the insurance company for payment of this bill.

So you need to be asking and talking with the insurance, filing an appeal to their decission not to pay, ( you have limited time to appeal) you need to write and call the State Insurance Commssioner and be sure to file a formal complaint againt this insurance company and depending on the amount limit for small claims court, perhaps file a suit against them in small claims court.

While doctors as a service bill insurance, in the end, from the true legal standpart of contacts, it is the customer or patient to actually be sure it is billed and to pay for the medical work if the insurance does not pay.

[RichardBondMan]

Whomeve didn't file until 03/07 seems to be the company to blame, try resolving either by tel or in person with that company promptly, write them a certified letter if you can't resolve promtly via tel or in person, ask them to resolve in 10 days or whatever is the earliest date you deem appropritate, at the same time, ask the insurance company to reconsider their original decision by either a formal appeal as outlined in your contract of insurance, get your agent and the state insurance dept involved. If it's a group policy, ask your employer to become involved also. Try to place all requests in writing to protect your interests. I was once billed for a radiologist office for services performed 18 months prior, wrote a letter to the radiologist who wrote back he was forgiving the debt since he failed to bill me timely. You have a much larger bill so if necessary, secure the services of an attorney.

[ScottGem]

Even if you did sign a contract to pay if the insurance doesn't, that doesn't absolve the doctor's office of negligence. I suspect the surgeon will eat it. If they don't, then contact your insurance company. But I doubt if they will win if it comes to court.

[tmart0123]

Thanks for all the suggestions, I will find out Monday what is going on. As for the statement that I should pay even if the DR neglects to bill my insurance, boy, then we should all worry when we go to the DR's office that we may end up w/ all the bills, and boy does that give a MD office such a "loophole" to screw up and eventually us as patients.

[kshif]

I work for a Home Health Company. When we have untimely filing, we have to write it off. We CANNOT bill the patient. Do not pay this bill. Tell them to contact the collection agency and cancel the collection process. If they do not want to cooperate, you can contact the State and contact JCAHO if they are accredited by them, and place a complaint for unfair and unethical billing practices.

[tmart0123]

Thanks for all the suggestions, the Dr office called yesterday and said that they will take care of the bill with their billing dept. They will send me something in writing stating that I am not responsible for any part of this bill. So this is now resolved.