I am covered by two insurance companies so my bills are paid @100 if properly submitted within the allowable time frame which is 15 months for my primary and 18 for my secondary.

I have recently run into a situation in which a collection agency called me on a bill from July of 2001 that was never submitted to either insurance company or billed to me so I could submit it. Had I noticed this, I would have told them, but I doubt it would have done any good.

I also have another one from a provider that billed the primary, but them never billed me or the secondary so since it was a small amount, I thought they just wrote it off.

My question is: What is the patient's legal reponsibilty if the provider fails to bill either your insurance or you within the allotted timeframe for the insurance to pay it. I'm in NJ if that makes any difference. Provider is in Pa.

Thanks,
Eileen

Eileen,
I'm sorry you have to face this. It can be very frustrating! Here's my initial response/request for more information:

> What kinds of insurance do you have? Is this an individual policy(ies) or through an employer? Has this provider filed claims on your behalf before or since these?

> Typically managed care contracts (HMO, PPO, etc) mandate that the provider file claims on your behalf. Indemnity contracts typically don't require this so it becomes the patient

hi,

i know of a similar case... hospital bills not submitted to insurance until after 12 months....

in that case: insurance policy clearly states that if bill not submitted, neither insurance co or individual is responsible...

the insurance co advised the individual that they were *not* responsible for the bill...

certainly we act responsibly, but hospitals are businesses that sign contracts with insurance co and they need to conduct normal business to be paid.

hopefully your case will be settled so that you are not put in financial distress.

cu,
larryb

Amy,

Sorry I didn't reply sooner, but have been busy. My primary is a PPO and my secondary BC/BS traditional. I have been dealing with this hospital since 1997 and they have the most screwed up billing dept I have ever seen. Spend half my life trying to straighten out bills that HAVE been paid with them.

Generally they submit to my primary and when I get the EOB and bill for the balance, I submit to secondary. I can also submit to primary but they never billed me either. This one just fell through the cracks in their billing dept and I didn't notice it with all the other bills and my condition.

I'm not asking you to help me resolve it. It was more of a academic question and you have answered it. If they want to collect this one, I would love to see them in court.

Thanks,
Eileen

Eileen,
Maddening isn't it! The buisness office at your hospital is not unique (hence why I don't worry about running out of work - unfortunately or fotunately depending on your angle). Sounds like your provider in the first secenario just cost themselves a bunch of money. In the second scenario however they could argue that you a responsbiel...right or wrong...they may try. I would call them and suggest they just go ahead and write all of off to save you all the grief.
Amy

Dear Eileen,

I know the frustration that comes with unpaid insurance claims. My husband sat down not long ago and reasoned that I had "saved" us 10's of thousands (most lately a bill for 9685.00 from the radiology dept) by being able to follow-up on these "lost" claims. Most are straightened out by calling the facility, verifying insurance information and requesting that they resubmit. Sometimes this includes faxing information, any pertinent EOBs that you might have, etc., but the hassle is usually worth it.

I thankfully (or ufortunately, as Amy so accurately described it) worked in insurance billing for years. My husband doesn't have a clue, and this chore has always been left up to me.

Now, not to pass judgement on any facility that someone might use here, but in my past, I have seen an office "accidently on purpose" double-bill patients. I only include this in case someone runs across the same outrage.

This particular doctor's office manager would collect on Medicare claims and then bill the patient for the discounted, or write-off amount, that the doctor had agreed to in his contract. I had to quit after spending many weeks covering for this manager while she had "business obligations." Needless to say, she was his wife, and regularly needed "downtime" in Vegas, Hawaii, Colorado, etc. I mean come on, her life was sooooo stressful! (smirk) I would listen to these retired men and women weep to me on the phone.....scared because they thought they owed hundreds or thousands of dollars on a fixed income. I couldn't take it. I would explain to them that their bill was taken care of, correct the accounting, only to get reprimanded when she returned and have her try and force me to call these patients back, and tell them that I was wrong!!!!

I've since worked for several doctors who are absolutely honest. I only hate that I was on my first medical job, and only 19 when I worked for this particular woman. I would have absolutely NO problem is turning this woman over to the proper authorities now, but we all live and learn.

I feel so badly for patients who have no background in insurance, and have no help in figuring it out. I've often wondered how I could use my experience in these matters to help them, but I'm now at home, and don't have a clue how to go about it.

Do you have any ideas Amy?

Love,
Mandi

Hi. boy your story is just like mine except we have 3 negative marks on our Credit Reports. We never owed any of the bills, the insurance company sent the bills in for "re-insurance". Dan's bills added up to more than 100,000.
My insurance company has written letters on our behalf to the Credit Agencies telling them we didn't owe the money, that the paperwork fell behind etc, so far the marks are still there. It has effected our Car and Home Insurance rates, we received letters stating that we don't get our discounts due to our credit rating.
We have had credit card companies lower our available credit...it goes on and on.
We did get the bills, but believe me, we did not have the 40,000 to pay the over due bills. We always called the collection agency and referred them to the Insurance Company who told them it was in process.

Good Luck.
Sherrie

Mandi,

First let me say that your offer to help others is great! And this forum is a great place to start. I get emails all the time from folks through this site asking for help. Some of it is very personal but where I come across a topic/response that is relevant for everyone, I post it. You are more than welcome to help and I

Thank you Amy....anything I can do at this point to help someone else may very well be the lesson I was supposed to learn while going through this with my husband..

I would be happy to help with any insurance questions that the board members might have, and hopefully the two of us can figure it out. If you are busy, and no one objects, forward the questions to me and I will do my best to answer within my experience. And like they say, sometimes two heads are better than one. And I've witnessed too many people with no prior experience with insurance get taken advantage of.

We are ALL in this together. To be able to contribute to someone at this time in their lives would make me feel productive.

Love,
Mandi

Thus far my problems have not effected my credit rating, but I was also told by a collection agency that is was illegal to do this since generally the bills are in either in the process of being paid or already paid.

Does anyone know if this is true? Does the law vary by state? Just curious.

Eileen

Dear Eileen,

Unfortunately, some businesses report unpaid bills to a collection agency as soon as their billing cycle shows those charges as late, and others turn the bills over to a so-called "in-house" collection agency.

This "in-house" agency is used solely to get your attention. It is still the same facility trying to collect payment, but doing so without hiring an outside agency. Once the bill is sent to an outside agency, the collecting facility must "pay" a portion of your bill to the company who finally gets payment from you.

Please email me, if that was confusing. Let me try again...

In other words, your doctor (hospital, radiologist, etc...) will threaten you first with a collection notice that is in fact part of their billing department. If you will call, (yes, sometimes kiss ass), they will work with you and try to figure out the problem. If you don't make an effort to communicate with this department over a certain period of time, sometimes 30-60-90 days, they will officially turn it over to a full-fledged collection agency. The facility is usually more than happy to deal with you first, because it takes less money out of their pocket in the long run.

As far as something being illegal in an attempt to collect a debt, I'm not sure. If you have evidence (returned checks, receipts of payment...etc.)that the facility has accepted, I know these can be used in your defense of trying to re-pay the debt.

I hope this helps,
Mandi