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  1. #1

    Default Medical Billing Waited Too Long, Now Want Payment

    This issue occured in Illinois.

    I had emergency room visit in September of 2007. I got all the bills and insurance covered everything.

    In January of 2009 I received a bill from a physicians group for $500 for the emergency room visit in September of 2007.

    My insurance company tells me they will not process as they have a 6month window for claims.

    The collection company tells me that they didnt have a contract with the insurance company so if they wont pay it now I am responsible for the full amount.

    If they would have simply provided me with a bill back in 2007 I would have had this resolved. Am I now responsible to pay this due to their error? Had they submitted this in 2007 Insurance would have covered 100% as my deductable had been met. The failure is on their part as they never informed me of a billing. I never received anything from this company until January 2009.

    HELP!! What should or can I do?

  2. #2
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    Default Re: Medical Billing Waited Too Long Now Want Payment

    If the Physician group did not have a contract with your insurance company, they are under no obligation to file a claim for you. You are responsible for payment.

    Pay them and ask for a receopt with the proper diagnostic & proceduure codes, then file an appeal with your insurance company. It's worth a try.

  3. #3

    Default Re: Medical Billing Waited Too Long Now Want Payment

    Quote Quoting lealea1005
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    If the Physician group did not have a contract with your insurance company, they are under no obligation to file a claim for you. You are responsible for payment.

    Pay them and ask for a receopt with the proper diagnostic & proceduure codes, then file an appeal with your insurance company. It's worth a try.
    Ok, I understand that part of it. But then why did they not give me a bill when I left the Hospital? I had no idea that I was being charged for this. They delayed sending me a bill for over a year causing me to lose benefits. And even though they claim no contract they did submit it to my insurance first and it was denied then they billed me.

    I would think at best they would be responsible for a portion of the bill?

  4. #4
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    Default Re: Medical Billing Waited Too Long Now Want Payment

    Quote Quoting geminitimelord
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    Ok, I understand that part of it. But then why did they not give me a bill when I left the Hospital? I had no idea that I was being charged for this. They delayed sending me a bill for over a year causing me to lose benefits. And even though they claim no contract they did submit it to my insurance first and it was denied then they billed me.
    I would think at best they would be responsible for a portion of the bill?
    They submited the claim as a courtesy, then had to wait to hear from the insurance company. They had six months to do that. We don't know how long it took for your insurance company to send them an explanation of benefits. Speaking of which.....if they submitted the claim, you must have received and EOB, as well. What does it say? If you can prove that they filed the claim within the timely filing period, you can still appeal the decision.

    In the meantime, the Physicians deserve to be paid for their services and have waited almost a year and a half to receive it. You need to remit your payment to them.

    Why in heavens do you feel entitled to a discount from Physicians who are not contracted by your insurance company, who submitted a claim for you, and who have waited so long to be paid??

  5. #5

    Default Re: Medical Billing Waited Too Long Now Want Payment

    Quote Quoting lealea1005
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    They submited the claim as a courtesy, then had to wait to hear from the insurance company. They had six months to do that. We don't know how long it took for your insurance company to send them an explanation of benefits. Speaking of which.....if they submitted the claim, you must have received and EOB, as well. What does it say? If you can prove that they filed the claim within the timely filing period, you can still appeal the decision.

    In the meantime, the Physicians deserve to be paid for their services and have waited almost a year and a half to receive it. You need to remit your payment to them.

    Why in heavens do you feel entitled to a discount from Physicians who are not contracted by your insurance company, who submitted a claim for you, and who have waited so long to be paid??
    WHY IN HEAVENS??? ARE YOU NUTS? I do not think you understand what the issue is here.
    • I never got a bill
    • They didnt submit to my Insurance until 15 months after the event

    I am not saying that the Physician should not be paid for their services. But what I am saying is that IF they WOULD have GIVEN me A BILL when I left the HOSPITAL or SHORTLY THEREAFTER, I could HAVE MADE SURE IT WAS PAID!! BECAUSE they DIDNT INFORM ME of CHARGES. I NOW DO NOT HAVE BENEFIT OF THE INSURANCE. THEIR POOR BILLING PRACTICES COST ME BENEFITS AVAILALBE. SO YES I THINK THEY ARE PARTIALLY RESPONSIBLE!!

    How about this If you wrecked your car and it went to the Body shop for repair. The Body Shop outsourced a specialist to fix part of your car. The bill was submitted to the Insurance company and paid. A year later the Specialist that fixed part of your car now submits his billing. Your insurance tells you the case is closed. So now you OWE the Specialist. And in your World he is owed for his services so why would you care just pay it? RIGHT?

  6. #6

    Default Re: Medical Billing Waited Too Long Now Want Payment

    Quote Quoting lealea1005
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    Why in heavens do you feel entitled to a discount from Physicians who are not contracted by your insurance company, who submitted a claim for you, and who have waited so long to be paid??
    He may not be entitled, but he is allowed to ask.

    One of the unfortunate aspects of our system is that if you're not covered you get charged more. Insurance companies negotiate better rates. However, individuals can negotiate as well.

    Work up the courage to ask. It's not just insurance companies that can negotiate. "The typical insurer gets about a 60 percent discount," explains Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. "If you go into the hospital and ask the chief financial officer, you may get a 30 percent discount, but you have to ask for it. It's totally up to the discretion of the CFO how much they or the person in the billing office are willing to give you."
    http://www.usnews.com/articles/busin...cal-bills.html

  7. #7
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    Default Re: Medical Billing Waited Too Long Now Want Payment

    Quote Quoting dansoc
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    He may not be entitled, but he is allowed to ask.

    One of the unfortunate aspects of our system is that if you're not covered you get charged more. Insurance companies negotiate better rates. However, individuals can negotiate as well.



    http://www.usnews.com/articles/busin...cal-bills.html

    The charges are the same whether one is insured or not. It is illegal to have separate fee schedules.

    If the Physician/provider is contracted with an insurance company, that company will only pay their "reasonable and customary" amount (which, IMHO, is neither). If the patient is not responsible for the ramaining balance, the Physician/provider must eat that amount. If the patient is not insured, or if the Physician/provider is not contracted with the insurance company, he/she may then charge their full fee.

    Of course, the patient is welcome to attempt negotiating a lower fee, but the Physician/provider is not obligated to accept.

    Would you accept 40% less than your usual salary because your company decided that's what was "reasonable"? Don't think so.

  8. #8
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    Default Re: Medical Billing Waited Too Long Now Want Payment

    Quote Quoting geminitimelord
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    And even though they claim no contract they did submit it to my insurance first and it was denied then they billed me.
    I responded to your statement above. Perhaps it is YOU that doesn't understand. Even if your deductible was met, you would have received an explanation of benefits from your insurance company for the services you were provided. When you didn't receive one, you could have called the Physician's office to see if the claim was paid, or what the status of the claim was.

    Again, pay them and appeal with your insurance company, or let them take you to court where they will win. It's your choice.

    You cannot compare auto insurance with health insurance. Car insurance claims can be reopened and additional work can be paid at a later date. Not necessarily so for health insurance. On the other hand, it the mechanic/auto body isn't paid, they will not release your car and charge you for storage until they are paid.

    It is really inappropriate to insult or yell at some one who is trying to help.

  9. #9

    Default Re: Medical Billing Waited Too Long Now Want Payment

    I am sorry if you think I was yelling.

    I guess what I am not communicating here is that I had no idea this Physicians office was billing. It was the emergency room The Hospital bill was paid and the Labs were paid. I have never had the Physician on duty send a seperate billing.

    I got the explanation of benefits and everything was Paid that I was billed for.

    What I didnt get was anything from this Physicians group. Their failure to bill me caused my Insurance to expire on their time frame they will handle claims.

    My issue is I never got any billing or ins info from this Group. Didnt know they existed until Jan 2009.

  10. #10

    Default Re: Medical Billing Waited Too Long, Now Want Payment

    My opinion is that they won't sue you for $500. But I wouldn't wait to find out.

    I would call the physician's group and explain to them the situation. It is understandable. People don't realize the multiple bills that can arise from such a situation. See if they will pull it back from collections and arrange for you to pay it and see that it is not reported on your credit report. Frequently, they will say they can't pull it back from collections, but typically they can. This is new enough, it probably hasn't been sold. Try to get the physicians group to cooperate with you on this.

    It won't hurt as mentioned to appeal with your insurance as well.

    I'm not sure why it was denied. Was it because they submitted it too late? You were in the ER. It's not like you get to choose your physicians.

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