Question
CALIFORNIA
Hi folks - thanks for any info as I am thoroughly confused about all this :-)
I received a bill from physical therapist visits from about 2 years ago. It seems they just never got around to sending the bill back in 2003 - they didn't bill the insurance company whose info I had given them, and they didn't send me a bill.
A few months ago, they sent me the bill directly. I called the office and told them they should bill the insurance company. As far as I know they have not even made an attempt to bill the insurance company (this is NOT an issue of insurance refusing to pay). Today, I got another bill. Should I just send this bill to the insurance company? Or try calling the office again to see why THEY aren't billing insurance? I don't know much about all this but I can't figure out why they are not sending the bill to the insurance company and not me. Thanks for any advice.
Answer
Unless they have signed a contract with the insurance carrier to do so (which happens with some HMO's), they are not obligated to send the bill to the insurance carrier. YOU received the services; YOU owe them payment. What contract you may have with the insurance carrier to pay some or all of your medical expenses is between you and the insurance carrier. The provider is not a party to that contract at all.
Yes, send the bill to the insurance carrier.
Answer
Ah, that makes sense - just seemed weird they didn't bill the insurance, but I'll send it the bill along to my insurance company and see if they'll pay it. Would they be allowed to refuse to pay it just because it's such an old bill (if otherwise it was a valid claim)?
Answer
Just about all insurance carriers have a point at which they will say no, that bill is too old, we won't pay it. As long as that point is listed in the policy and they abide by it, yes, they can. I have to tell you, there's a VERY strong likelihood that this will happen. I have yet to see an insurance policy that will pay a bill that is submitted for the first time after two years.
At that point, your only option is to fight it out with the provider. It's not the insurance carrier's problem.
But you never know. It's also possible that the provider DID submit it to the carrier initially and it wasn't paid for some reason; missing information, most likely. (If that's the case, it's almost certain that at some point you were sent notice of what information was missing so that you could help expedite it.) In any case, you never know until you try.
Answer
Ah well, worth a shot. The office is just billing for the first time as far as I can tell- dunno what happened there! (maybe paperwork fell behind a desk and they just found it?) so that is kind of a pain, but I guess I could've followed up to see what was going on with billing in '03- just assumed it had been sent to insurance and paid... but what do they say about assuming things...
Answer
Ok, IF the doctor you saw is contracted with your insurance company, AND your insurance denies the claim for late submission, THEN you will not be responsible for the bill. It is the doctor's problem that they did not submit it on time and they will have to either fight it out with your insurance (for example showing proof of timely filing) or write it off. So long as they are a contracted provider, legally they can not bill you for this service if your insurance denies for this reason.
However, if you were seeing an out of network doctor, you WILL be responsible for the bill if your insurance denies it. If that's the case, you may be able to appeal to them by saying that the doctor didn't send it to you until this date, and show proof. They don't have to honor it, but they might.