Question
What is the name of your state? NY
In 9/2005 I visited the emergency room with a dislocated shoulder. A few weeks later I had surgery for this same condition. My health insurance covered all of the costs (or so I had thought). Just a few weeks ago, I received a bill for the emergency room visit. The bill stated that my insurance company had been billed, but I was responsible to pay the bill and my insurance company would reimburse me. Because of the length of time the billing company waited to bill my insurance for the visit, my insurance company denied the claim.
If the billing company had invoiced my insurance company in a timely manner, my insurance would have paid the claim (all costs for the surgery were covered). The insurance company told me that they have a 4 month limit for claims; the billing company waited 15 months to bill my insurance.
Am I responsible to pay this bill?
Answer
Am I responsible to pay this bill?
Yep. A lot of people assume that the insurance company is somehow obligated to pay the hospital... but that is not true. YOU (the patient or guarantor) are responsible.. and the insurance company reimburses you (the is the way it was originally).
As a 'service' to their policyholders (to 'lower clams' and as a marketing ploy to gain entry into hospitals, doctors, etc.), the insurance company's put themselves in the position of allowing 'direct billing' between the medical provider and themselves. However, that does NOT make them liable for YOUR bills.
Pay the hospital... then pursue your claim against YOUR insurance company... in court if necessary (however, you need to READ your insurance policy for claim practices).
Answer
Q: Am I responsible to pay this bill?
A: Yes.
Q: Do you think I'd win in a lawsuit against my insurance carrier if everything I said in this post was 100% correct and accurate AND I could prove it in court?
A. Yes.
Answer
Thanks for the quick replies. I will take this up with my insurance company.
So, in general, there is no ' statute of limitation' for billing? That is, a company has no responsibility or obligation to bill for services in a timely manner, they can wait as long as they would like? (I'm not trying to be argumentative, just curious).
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So, in general, there is no ' statute of limitation' for billing? That is, a company has no responsibility or obligation to bill for services in a timely manner, they can wait as long as they would like? (I'm not trying to be argumentative, just curious).
Of course, that is NOT true... nor is it what was said.
The debt can last forever.... but your legal obligation to pay it would expire at the end of the applicable SOL (Statute of Limitation) as set by your state laws.
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Of course, that is not what was said. As I mentioned, I was curious as to whether or not there is a SOL for billing for services, which you answered for me. Thanks!
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Actually, there is a VERY relevant piece of information which you haven't provided: Is the hospital contracted with your insurance company, or is it "out of network"? A CONTRACTED hospital is contractually forbidden from billing the patient for claims that the insurance company denies for lack of timely filing. It is THEIR fault that the insurance didn't pay and so they can not hold YOU responsible.
An out of network hospital has no agreement with your insurance company and so they ARE allowed to bill you for this, and you will have to pay them. I don't believe any court action against your insurance company to be reimbursed for this would be successful, either, they have abided by the terms of their contract with you (i.e. your insurance policy) and they are not responsible to pay for anything outside of their plan guidelines.
Answer
Actually, there is a VERY relevant piece of information which you haven't provided: Is the hospital contracted with your insurance company, or is it "out of network"? A CONTRACTED hospital is contractually forbidden from billing the patient for claims that the insurance company denies for lack of timely filing. It is THEIR fault that the insurance didn't pay and so they can not hold YOU responsible.
An out of network hospital has no agreement with your insurance company and so they ARE allowed to bill you for this, and you will have to pay them. I don't believe any court action against your insurance company to be reimbursed for this would be successful, either, they have abided by the terms of their contract with you (i.e. your insurance policy) and they are not responsible to pay for anything outside of their plan guidelines.
I just double checked their web site, and the hospital IS in their network. I'll be calling the billing company and insurance carrier tomorrow
Thanks for the advise ecmst!
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That's great news, good luck! Let us know if they remove the charges for you