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  1. #1

    Default Doctor Didnt File Claim and Now Collections Agency Harassing Me

    My question involves insurance law for the state of: California

    During the birth of my daughter in June 2006, a resident doctor of the hospital was involved. He never presented his claim to Aetna which was my insurance provider at the time. Aetna settled every other claim and i didnt have to pay anything for the delivery.
    Last year doctors office sent me a bill for $2000 and i contacted Aetna which told me that doctor had not filed a claim within the period permitted and now Aetna wont pay. I conveyed this to doctors office.
    Now, Doctor has sent the bill to a collection agency which has hired a lawyer and they are threatening to sue me for the amount and additional fees and interest.

    Can you please advise what i can do in this situation? I will be very grateful.

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    17,624

    Default Re: Doctor Didnt File Claim and Now Collections Agency Harassing Me

    You can pay the bill. You received the services and the doctor is entitled to be paid.

    Unless there is something in the policy that SPECIFICALLY states that the doctor is the one responsible for submitting the bill to the insurance, he does not have to do so. It is YOUR responsibility to see that the insurance company receives the bills, not the doctor's. And the chances are about 98% that you signed something stating that you would be responsible for payment.

    Talk to the doctor about scheduling a payment plan if you need to, but it's YOUR credit that's going to be affected if the bill remains unpaid.

  3. #3
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Doctor Didnt File Claim and Now Collections Agency Harassing Me

    I'm curious...a resident Physician is usually an employee of the teaching hospital/residency program and does not have a separate private practice. Are you receiving bills from the residency program, the OB/GYN clinic, or the specific Physician?

    If it's from the specific Physician, he cannot bill separately (like it was a service provided after the start date of his current private practice) for services provided while he was still an employee of the residency program.

  4. #4
    Join Date
    Jul 2008
    Posts
    471

    Default Re: Doctor Didnt File Claim and Now Collections Agency Harassing Me

    Because doctors are so good about filing claims we forget they are doing so as a courtesy to us. But they don't have too, It used to be you paid the doctor and the insurance company reimbursed you. An unpaid hospital bill will hurt your credit, In my case I couldn't buy a house until I paid an old doctor debt. Fortunately there wasn't all the interest they add nowadays.

    So you got stuck here. However I would keep squawking at Atena and call the insurance commissioner in your state.

  5. #5
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Doctor Didnt File Claim and Now Collections Agency Harassing Me

    Quote Quoting kist
    View Post
    Because doctors are so good about filing claims we forget they are doing so as a courtesy to us. But they don't have too, It used to be you paid the doctor and the insurance company reimbursed you. An unpaid hospital bill will hurt your credit, In my case I couldn't buy a house until I paid an old doctor debt. Fortunately there wasn't all the interest they add nowadays.

    So you got stuck here. However I would keep squawking at Atena and call the insurance commissioner in your state.

    Actually, when a Doc signs contracts with most insurance companies, nowadays, the contract requires that the Doc files the claim for the patient, and within a "timely filing period". If it's not filed within the specified period, and the Doc is contracted, he/she cannot collect from the patient.

  6. #6

    Default Re: Doctor Didnt File Claim and Now Collections Agency Harassing Me

    Thank you so much for the answers. I appreciate the help very much.

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