I have a complex problem with services provided to me by a hospital in Denver Colorado. I was in an auto accident in April of 2005. I have had several surgeries since that accident. In December of 2005 I had surgery at this hospital. After this surgery I developed a very bad staph infection and had to be hospitalized at a different hospital. I was out of work for a month. I received bills from this hospital for $3033, I was already in debt from being out of work and I could not pay the bills. In December of 2007 I received a court summons that I was being sued by this hospital for the above amount. I consulted the lawyer I have for the accident and he informed me that their firm does not handle collections issues but suggested that I file an answer to the summons and deny liability for the claim. I did that.

It occurred to me that I did not have a bill of the itemized charges from the hospital, so I contacted their billing department to obtain one. They would not discuss the matter with me since it had been turned over to collections. I reviewed the many medical claims I had had in the last two years on my insurance company’s web site, and I noticed that there was not even a denied claim for the hospital. I contacted my insurance company to ask them if they had ever received a claim from this hospital. They reported to me that they had no record of this hospital ever submitting a claim to them for me. They also informed me that this hospital is a PPO provider and it is a violation of their contract with this insurance company for them to send me a bill without filing a claim with them first. My insurance company contacted the hospitals billing department and informed them of this. I also spoke to numerous people in the billing department there. They said that they would re-submit the claim and that I would still be liable for the interest on the amount and court costs and attorney fees. I relayed to them that that was not acceptable to me since they made an error submitting the claim and that was not my fault.

The person in charge of collections at this hospital informed me that my insurance claim had been submitted to my insurance company without the alpha prefix on the insurance id. I informed her that I did not understand why they had not corrected this since they made a copy of my insurance card that has the correct number before I ever had the surgery and I did not understand why they had not retrieved that copy and got the correct id.

I was informed that the lawsuit was on hold pending payment from my insurance company. I returned to see the Surgeon that performed the surgery in 2005 because I need to have surgery again. I let him know I was concerned I would not be able to have the surgery because the hospital he practices at was suing me. He was shocked about this and had me talk to his assistant who has a family member that works at the hospital in the billing department. She was amazed that they had not been paid because they submitted their claim for charges on the 2005 surgery and received payment from my insurance company in two weeks. They had their family member look up the claim and said that in addition to submitting the claim without my correct insurance id they also had sent the claim to the incorrect office when and they should know to send the claim to the local plans office.

I have been checking with my insurance company to see if a claim has been submitted, and I have not seen one, concerned about this I contacted the hospital’s billing department again and was assured that they had submitted the claim again. I just received a letter in the mail from my insurance company noting that the time limit for filing claims is 12 months from the date services were provided and that since the charges of $11645.04 was filed after the end of the time limit no payment can be made under the terms of my benefit plan.

I am very concerned that I am now going to be sued by the hospital for the total amount of the claim of 11,645.04 which is even worse then the PPO allowed payment of $3033 with my insurance. I don’t know what my rights are in this matter, but It seems to me that this hospital made several errors billing my insurance company for these services, and I do not feel that it is fair or just for me to be held responsible for their mistake. Can you provide me with any information on what if any legal rights I have in this situation?


Thanks,
Rebecca Burnham