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  1. #1
    Join Date
    Jan 2011
    Posts
    17

    Default Late Claim to Insurance

    Last August, my wife was getting a treatment and a provider sent a bill. At that time, she had two insurance - individual and from work. I called to the provider and specified both insurances and was told everything is OK, put the bill aside. I do not know what they were doing for six months, but only in February we received an EOB from the individual insurance with a waiver due to pre-existing conditions and, immediately, another bill from the provider. Called them again and asked if they claimed to the second insurance? Got an answer: Oh, everything is OK, throw out the Bill, right now we going to clime the second one. Yesterday I received an EOB from the second insurance with refusal by reason: the time frame for claim submission has expired.
    Obviously, this is a provider's fault. But it looks now, like I'm responsible for this debt. Is there any way to resolve this situation?

  2. #2
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Late Claim to Insurance

    Six months may have been well within the timely filing period for the first insurance plan, but not for the secondary. Is the provider in network (contracted) with the secondary insurance plan?

  3. #3
    Join Date
    Jan 2011
    Posts
    17

    Default Re: Late Claim to Insurance

    Yes, it's in-network provider.

  4. #4
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Late Claim to Insurance

    IF they are network provider and under contract with your insurance company, there may be a chance that they are not permitted to collect from you if the claim wasn't submitted within their timely filing period. Start by calling the insurance company and ask about this.

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