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  1. #1
    Join Date
    Sep 2016
    Posts
    2

    Default Medical Provider Did Not Send Correct Paperwork and Now Past One Year Timely Filing

    My question involves collection proceedings in the State of: CO
    Date of service was 2/27/2014. Provider submitted claim on 2/28/2014 to which our insurance requested additional information on 3/12/2014. I received an EOB with codes advising determination and immediately called providers office. Provider completely assured me they would get the necessary info to insurer. I followed up several times receiving same assurance that they would resubmit but having a hard time pinning down Doctor to complete info. Never heard anything from provider or insurance company until 9/23/2016 when provider calls to settle account. Called insurer to understand status and timeline. Provider resubmitted 10/13/2014 and again insufficient narrative and film(unaware at this point that it was not settled - no EOB sent to us) as Insurer responded only to provider what they needed and that they could call to provide information. Insurer never heard anything from provider until a resubmittal 9/6/2016 which was denied due to untimely filing. We paid our coinsurance on date of service and now provided is looking for remaining amount that insurance would have paid. What are our rights?

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Medical Provider Did Not Send Correct Paperwork and Now Past One Year Timely Fili

    What kind of policy do you have? HMO, POS, PPO, HDHP, indemnity, something else?

    It matters to the answer.

  3. #3
    Join Date
    Sep 2016
    Posts
    2

    Default Re: Medical Provider Did Not Send Correct Paperwork and Now Past One Year Timely Fili

    This is a dental provider so it is under Delta Dental PPO

  4. #4
    Join Date
    Jan 2006
    Posts
    38,867

    Default Re: Medical Provider Did Not Send Correct Paperwork and Now Past One Year Timely Fili

    Quote Quoting phxallie
    View Post
    This is a dental provider so it is under Delta Dental PPO
    Then the provider is bound by their contract with delta. If the provider is not allowed to balance bill a customer or just bill a customer if the provider has not taken all necessary steps to collect from the insurance provider, well, they're out of luck.


    Contact your insurance provider and discuss this with them.

  5. #5
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Medical Provider Did Not Send Correct Paperwork and Now Past One Year Timely Fili

    Quote Quoting jk
    View Post
    Then the provider is bound by their contract with delta. If the provider is not allowed to balance bill a customer or just bill a customer if the provider has not taken all necessary steps to collect from the insurance provider, well, they're out of luck.


    Contact your insurance provider and discuss this with them.
    Agreed.

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