Question
What is the name of your state? new york:
Have health insurance with United Furniture Workers Insurance Fund which is head-quarted in Nashville, TN. I worked for a small family owned employer and our union used this health insurance company.
I needed emergency medical treatment in 2003. I gave ins. card to hospital who already had me on file and could confirm I was insured. Why the hospital never submitted to insurance company, I'll never know. In any case, I found out through my credit report that this debt was handed over for credit collection.
I contacted Insurance company and they have denied payment because the claim is more than 1 year old. I appealed and gave them proof that this same medical facility had submitted for payment before and did in fact have my insurance information on file. So why didn't they do it this time? Who knows!
Is there any legal recourse in the matter? Is there some law I can reference? I can't afford hospital bill and collection agency is destroying my credit. I was insured at the time of services and don't understand how they can legally deny payment.
Answer
not sure about NY, but the contract our Physician's sign clearly states if a claim is not filed from our office within their specified time limit (usually 90-180 days, depending upon the company) we cannot collect from the patient.
call your insurance company again and see if this also applies to your state. then call the patient accounts office at the hospital and speak to a supervisor.
one question.....usually the Physician group workingin the ER are independent contractors....have you received an explanationof benefits from your insurance company indicating they were paid?
good luck
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Also, how did a bill end up being sent to collections without you knowing about it? The original creditor would have sent bills, and made phone calls. Then the collections agency would have sent bills, and made phone calls. I don't get it. You didn't open your mail, or something?
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good point moburkes! feel like a dummy for not thinking of that one
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Thanks for you replies & information.
Invoice was sent to address where I moved out of within 30days after treatment. Moved in with friends for about a month and then found another apartment. Registered with Post Office and don't ask me why I didn't get a follow-up bill because I didn't.
Funny the only reason I found out there was an outstanding bill is because I check my credit report and found out. I have filed and appeal with Insurer informing them of this and I also included a previous invoice from same provider proving they had submitted claims on other medicals.
So, in actuality I believe the provider is at fault and yet I am paying the consequences of their actions. No, they don't want to "hear about it" because it's not their problem. Of course it's their problem...I'm in the hospital database, admissions actually said, "oh, you've been here before" and yet some "dope" didn't fill in the appropriate insurer's box!
So, with all that being said I wonder if there is anywhere I can turn for help. Any legal references to something like this?
Thanks for your concerned replies.
Answer
if it was eventually filed with the health insurer and was rejected for being outside the "timely filing" limit, that will be indicated on an explanation of benefits (EOB)...you need to get a copy. It is also possible that the EOB will indicate whether the provider cannot collect from the patient (subscriber). the easiest and least expensive way to find out is to call your health insurer and get a copy of the EOB.
Answer
Once again, thanks for reply. I did get a copy of original invoice/eob from hospital and in the box on their form "this is the current insurance information" the hosptial did not fill-in any information. They say, "we had no insurance information therefore you were personally responsible for invoice." I told them the admitting officer mentioned I was in their 'system" from a previous time, I confirmed I still had same insurance company and even left my card with admitting (in fact, I never got card back) and their response to that was..."it is not our policy to look at older invoices to determine coverage, the onus is on the insured" I guess they're actually denying any responsibility in this matter and the admitting agent is "off the hook" but my credit is still affected.
I guess I was hoping there was some 'legal' precedent or reference to something like this. I guess I'm just "out of luck" on this one. How come the "little guy" always has to pay the price?
Thanks