Statute of Limitations on Medical Billing?

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archbish99
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Statute of Limitations on Medical Billing?

Post by archbish99 »

Our insurance policy has a requirement that all services have to be billed to them within a year of the date of service, which is more than reasonable -- they have to be able to close out the books on previous customers and past years at some point, after all.

However, we've got a number of places now (one lab test, one out-of-town urgent care visit) that haven't billed insurance or us for several months. The urgent care place I don't mind calling, but I don't even know what lab actually did the test in question, just that the doctor sent it out and we got results. And my experience in the past has been that when I call places about bills they haven't sent out, they get... somewhat confused. Others have billed insurance, but never billed us for the coinsurance (or taken a long time to do so).

We've only once had a provider delay remotely close to the limit -- another doctor-sent-to-lab, and the lab only had our name and phone number. But rather than calling to ask for our address or insurance information, they turned the bill over to a collection agency who, oddly enough, thought to dial the number and ask us to pay. We insisted they bill insurance first, and agreed that obviously we would pay whatever balance was due after insurance. Everything was eventually straightened out, but they were right at the one-year mark before it was.

If a provider waits past the filing limit to submit a payment to insurance, does that make us responsible for the whole cost because of their delay? Is there a point past which they aren't able to bill us either? How do other people handle bills that don't materialize promptly?
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earlyout
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Re: Statute of Limitations on Medical Billing?

Post by earlyout »

I don't know if this is governed by state law or by the contractual arrangement between the provider and the insurance company. My only experience was a few years ago when a physical therapy provider billed the insurance company about 18 months after the therapy. The insurance company refused to pay and told me I did not have to pay. I didn't receive any more requests for payment and as far as I know the provider did not collect for the services.
toofache32
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Re: Statute of Limitations on Medical Billing?

Post by toofache32 »

This is easy. What does your contract say?
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archbish99
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Re: Statute of Limitations on Medical Billing?

Post by archbish99 »

About what insurance will pay, it's easy:
Exclusions and limitations
  • ...
  • Services for which claim was not received by [company] within 12 months of the date of service. Corrected claims and COB claims need to be submitted within 12 months from the original claim submission date.
About what I would then have to pay the provider...? Not sure.
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leonard
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Re: Statute of Limitations on Medical Billing?

Post by leonard »

There is no way for a patient to manage the Billing, AR, and AP between doctors, laboratories, and insurance. It's simply not possible to track everything a doctor does that incurs a bill or charge, let alone that all financial settlements are happening.

Plus, timely transaction processing is one of the things that is being compensated in the bill. So, it's their responsibility to get it together.
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staythecourse
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Re: Statute of Limitations on Medical Billing?

Post by staythecourse »

I would think if the claim is not done in the 12 month period then it is NOT your responsibility as it is their fault. Otherwise, any provider could just "accidently forget" the 12 month limit and then stiff the consumer with the bill. That would seem pretty unethical.

I'm a physician and must say you are a better man/ woman then me. I don't even worry about the bill until I get it in my hand. That is their responsibility to get done as they have the most amount to lose.

Good luck.
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TX_TURTLE
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Re: Statute of Limitations on Medical Billing?

Post by TX_TURTLE »

If the lab is an 'in network' provider they should have signed an agreement, with the insurance company, to submit their claims within a specified time frame. If this is the case, you shouldn't have to pay for their errors. Of course, this doesn't mean that they will not try to collect and force you to spend time to prove they are wrong...
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archbish99
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Re: Statute of Limitations on Medical Billing?

Post by archbish99 »

staythecourse wrote:I'm a physician and must say you are a better man/ woman then me. I don't even worry about the bill until I get it in my hand. That is their responsibility to get done as they have the most amount to lose.
I wouldn't go that far.... I just don't like having bills (particularly if they're large) hanging out in limbo. I know I owe them, and I would rather have the payment booked and done with than forget about it and get a surprise bill down the road. I'm more pragmatically trying to protect myself from the possibility that insurance will refuse to pay because they're late and they'll come after me.

The argument that in-network providers would be required to eat the cost if not submitted within the insurance company's required time is certainly possible, but I have no visibility into that contract. (And then there's the fact that, for labs, I have no control over whether the doctor used an in-network lab.)
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potatoman
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Re: Statute of Limitations on Medical Billing?

Post by potatoman »

archbish99 wrote:I wouldn't go that far.... I just don't like having bills (particularly if they're large) hanging out in limbo. I know I owe them, and I would rather have the payment booked and done with than forget about it and get a surprise bill down the road.
My thoughts are in line with yours. All you're trying to do is deal with a minor issue now to avoid a big headache down the road. Seems reasonable and I've done the same when nothing showed up in my insurance EOBs for 45 days following a ct scan. Prod them along every now and then by calling the place who performed the work. If you have no info as to who did the work, call the doctor's office and ask how to proceed and don't hang up without getting enough information to move forward.
Mudpuppy
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Re: Statute of Limitations on Medical Billing?

Post by Mudpuppy »

I had a similar situation in the past. The doctor's office sent the initial bill to the insurance, which then asked for followup documentation from the doctor. The doctor did not send the documentation, even after repeated prompting by both the insurance and the company which handled his billing. I had paid my co-pay for the office visit, but I had not paid anything for the test in question.

After there was no response to the initial request by the insurance company and also when we approached the 12 month limit, I called the company that handled his billing and they basically said it was his problem, since he and his office staff had been repeatedly notified of the form the insurance needed filled out. On the call before the 12 month point, they said they would send one more notification, but if the doctor did not respond, I was not on the hook to pay for his inability to file requested paperwork.

I don't know if that was legally binding advice or just the terms of the contract that doctor had with that billing company, but that was years ago and I've never been billed for it.
Ninegrams
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Re: Statute of Limitations on Medical Billing?

Post by Ninegrams »

On the one hand if they're in network, then one would think that the contract would govern. On the other hand, some practices tend to view billing insurance as a "courtesy" and that you are responsible for full payment in any event, and have you sign paperwork to that effect. Did you sign any paperwork that may have had some payment clause in it?
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archbish99
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Re: Statute of Limitations on Medical Billing?

Post by archbish99 »

Not for the lab; probably for the urgent care.
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Professor Emeritus
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Re: Statute of Limitations on Medical Billing?

Post by Professor Emeritus »

one option, which I used once with success for my mother was to file with the insurance company a "claim" which I generated myself. It had the name of the provider the date of service and every piece of information I had. I included the notation "final cost of services not yet determined." that filing met a bare legal definition of a claim. It put the Insurance company "on notice" They opened the claim and waited for the sum certain.
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archbish99
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Re: Statute of Limitations on Medical Billing?

Post by archbish99 »

An update on an old thread -- I took a few minutes and called a few of my "old moldy" medical bill holders, where they'd processed through insurance but never billed me.
  • One had excessive wait times, so I submitted a request on their web site. Haven't heard back yet.
  • One automatically writes off patient obligations below a certain threshold and doesn't bother sending a bill. Based on other threads I've read, this may be a violation of their contracts with the insurance provider, but hopefully doesn't impact me negatively.
  • The final one (out-of-network, and sizable) billed insurance and got a tiny fraction, never billed us for the remainder, and wrote off that remainder at a year past the date of service. They're sending us a statement copy confirming that we don't owe anything.
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