Challenging a Late Medical Bill

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LandOLakes
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Challenging a Late Medical Bill

Post by LandOLakes » Tue May 16, 2017 8:40 pm

My wife gave birth to our first child approximately two years ago. Because of unforeseen complications during delivery, the baby was rushed to the NICU soon after birth and stayed for roughly a month. Thankfully, and most importantly, today the baby is doing great.

Insurance covered virtually all of the cost of care, but a week ago we received a bill for $800 for services rendered in July 2015. I had not received anything from the hospital related to this event for a year or so. We spoke briefly to someone in the hospital billing department who said it related to a copay. I have since changed jobs and need to dig up my insurance coverage from back then to confirm.

Before doing so, however, it occurred to me to ask whether there is any limitation, formal or informal, against billing for services so long after the fact. I know the statute of limitations on the debt has not run. But it still surprises and aggravates me that we are still being billed for this event so long after the incident. In what other context is it appropriate to continue charging someone in dribs and drabs for services provided over a year earlier?

Anyway, it's totally possible I'm totally wrongheaded here, and the simplest thing may be to pay the bill and be done with it. But I'm curious if anyone has wise suggestions for ways to push back or suggest that the hospital consider writing off the amount (I believe they have already collected something like $250K+ from insurance). And if I'm griping about something that's really just par for the course, tell me that too!

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8foot7
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Re: Challenging a Late Medical Bill

Post by 8foot7 » Tue May 16, 2017 8:46 pm

Our insurance policy has a six month limit on charges--they refuse to pay charges presented more than six months after service and as part of their contract with hospitals etc they hold the consumer harmless for bills not timely presented. We actually just went through this for our second son--hospital attempted to bill baby's room and board nine months after the fact--they had already billed and been paid for mom's room and board. I sent a note politely telling them to stick it where the sun don't shine. If they can't get their ducks in a row then that's no longer my problem.

IMO
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Re: Challenging a Late Medical Bill

Post by IMO » Tue May 16, 2017 8:58 pm

I'm interested in how this turns out for you.

Did the hospital submit to insurance already for that service in July 2015? It can often be helpful to physically to down to billing department at the hospital/clinic to discuss the specifics of the bill, was it submitted, denied, etc.

I find that mail delivery has become much less reliable, and maybe something was sent to you, but you did not receive it in the mail. We constantly get other people's mail delivered to us on a regular basis (and not just at our current home).

I'd be careful on just ignoring the bill. Typically when you sign paperwork at hospitals/clinics you are signing that you are ultimately responsible for any uncovered bills/deductibles.

Once had a situation where my insurance paid for the MRI, but for some reason the radiology reading which was a separate bill did not get properly paid. Out of frustration on not getting things resolved, I did not pay it and that $300 charge kept coming up on my credit report (and even had collection agencies calling/hassling me).

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Watty
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Re: Challenging a Late Medical Bill

Post by Watty » Tue May 16, 2017 10:12 pm

A couple of things;

With all the other bills related to the NICU I would think that it is likely likely that you hit your individual or family out of pocket maximum for that year. If they are just now billing the insurance company that should be taken into account.

My understanding is that some of the billing restrictions may be different with in-network and out-of network providers so be sure to find out which they are.

It is possible that you already paid it but they did not apply the check correctly. I would ask for a full transaction history that you can review. I have had billing problems with bills that were open when a computer conversion was done.

toofache32
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Re: Challenging a Late Medical Bill

Post by toofache32 » Tue May 16, 2017 10:17 pm

Glad to hear the baby is doing well. The real question is when was the claim adjudicated (finally approved, denied, etc). It could be that the provider has been trying to get payment from the insurance company this entire time. When I was an in-network doctor with insurance plans, my record was 18 months to get a claim adjudicated. Only after they finalized the claim was I able to know how much to bill the patient for their part. This was for a 10 hour surgery.

Find out if the insurance company has been dragging their feet the entire time. They do this hoping that claim will fall to the bottom of the doctor's priorities so the doctor will no longer chase the claim.

z91
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Re: Challenging a Late Medical Bill

Post by z91 » Wed May 17, 2017 5:28 pm

I received a bill from a hospital a few weeks ago, for services allegedly rendered last year. I hit the maximums last year so I knew I wouldn't owe anything, but called them up anyway in case they decide to send me to collections.

The bill noted, "Call this number if you have any questions" so I called it. Someone picks up and states, "Hi, are you paying a bill today?"

"No, I had a question about the bill."

"OK, looks like your bill is due next week for services rendered last year related to a co-payment." This response was basically everything that was listed on the bill in front of me, so it was not useful. I pushed for more information and asked for another number to call. Before hanging up they said, "Are you sure you don't want to take care of this bill now? It's due in X days"

I politely declined, they pushed further, and wouldn't stop "selling" me to pay the bill until I simply stated "I dispute the charge." They gave me the number to call and asked if I wanted to be automatically transferred. They then did one of those blackhole transfers where I get hung up on.

The second person was much nicer, didn't expect me to pay the bill, and simply stated to ignore it. I called the bill collector back and the charge was removed.

In summary, healthcare billing is really messed up, and don't be scared to call them up to ask why it's taking so darn long. IMO if you ignore it, they could probably send it to collections. But, if you are actively disputing it, it will probably delay liability of the payment in most cases, ideally to the point of you not having to pay.

toofache32
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Re: Challenging a Late Medical Bill

Post by toofache32 » Wed May 17, 2017 7:51 pm

t60 wrote: The bill noted, "Call this number if you have any questions" so I called it. Someone picks up and states, "Hi, are you paying a bill today?"

"No, I had a question about the bill."

"OK, looks like your bill is due next week for services rendered last year related to a co-payment." This response was basically everything that was listed on the bill in front of me, so it was not useful. I pushed for more information and asked for another number to call. Before hanging up they said, "Are you sure you don't want to take care of this bill now? It's due in X days"

I politely declined, they pushed further, and wouldn't stop "selling" me to pay the bill until I simply stated "I dispute the charge." They gave me the number to call and asked if I wanted to be automatically transferred. They then did one of those blackhole transfers where I get hung up on.
This is exactly what happens when doctors offices call insurance companies. Hard to find someone who can help, misinformation commonly given, and frequently get hung up on after being on hold for 30-60 minutes.

an_asker
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Re: Challenging a Late Medical Bill

Post by an_asker » Wed May 17, 2017 7:59 pm

LandOLakes wrote:My wife gave birth to our first child approximately two years ago. Because of unforeseen complications during delivery, the baby was rushed to the NICU soon after birth and stayed for roughly a month. Thankfully, and most importantly, today the baby is doing great.

Insurance covered virtually all of the cost of care, but a week ago we received a bill for $800 for services rendered in July 2015. I had not received anything from the hospital related to this event for a year or so. We spoke briefly to someone in the hospital billing department who said it related to a copay. I have since changed jobs and need to dig up my insurance coverage from back then to confirm.

Before doing so, however, it occurred to me to ask whether there is any limitation, formal or informal, against billing for services so long after the fact. I know the statute of limitations on the debt has not run. But it still surprises and aggravates me that we are still being billed for this event so long after the incident. In what other context is it appropriate to continue charging someone in dribs and drabs for services provided over a year earlier?

Anyway, it's totally possible I'm totally wrongheaded here, and the simplest thing may be to pay the bill and be done with it. But I'm curious if anyone has wise suggestions for ways to push back or suggest that the hospital consider writing off the amount (I believe they have already collected something like $250K+ from insurance). And if I'm griping about something that's really just par for the course, tell me that too!
Funnily, this exact thing (not the complications, thankfully, but the late bill!) happened to us - about a decade ago. Kid was born in 200x and we got the bill in "200x+2". I'd changed jobs and moved to another city and had never received the original bill. We received a letter from collections in "200x+2"!!

Fortunately, we were on an HMO that covered the entire delivery process, so I knew there is no way we should have been even billed for the services. Also, fortunately, after digging up the insurance information and talking with the insurance personnel, I was able to get in touch with the office manager of the OB/GYN involved as well. The exact details elude me (it has been about a decade after all!) but somehow the collections letter was rescinded and we were not required to pay the billed amount (insurance took care of it one way or the other I would think).

an_asker
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Re: Challenging a Late Medical Bill

Post by an_asker » Wed May 17, 2017 8:04 pm

toofache32 wrote:[...]When I was an in-network doctor with insurance plans, my record was 18 months to get a claim adjudicated. Only after they finalized the claim was I able to know how much to bill the patient for their part. This was for a 10 hour surgery.[...]
As patients, my wife and I beaten your record twice, not once!! Once after delivery (discussed in previous response) and once earlier this year, when I got a bill from the doctor for services rendered in 01/2015. Funnily enough, I cannot find the eob online anymore - the dang insurance only lists eobs for the last two years ... of service not adjudication!! :oops:

PS: I am really curious - with a name like toofache, I thought you were a dentist (or oral surgeon). But I cannot think of oral surgery that can be 10 hours long. Or can it really get that long?!! :confused

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dm200
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Re: Challenging a Late Medical Bill

Post by dm200 » Wed May 17, 2017 8:08 pm

Unless someone can cite a reference, contrary to common belief, I do not believe there is a statute of limitations on paying or being obligated to pay a legitimate obligation in the past.

These kinds of things are very annoying, to say the least. Going back two years and having changed insurance, it can become very difficult to verify the legitimacy of such a bill.

What I would wonder about is whether this may have been somehow stuck in the provider and insurance process - that can go on for a long time.

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dm200
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Re: Challenging a Late Medical Bill

Post by dm200 » Wed May 17, 2017 8:12 pm

toofache32 wrote:
t60 wrote: The bill noted, "Call this number if you have any questions" so I called it. Someone picks up and states, "Hi, are you paying a bill today?"

"No, I had a question about the bill."

"OK, looks like your bill is due next week for services rendered last year related to a co-payment." This response was basically everything that was listed on the bill in front of me, so it was not useful. I pushed for more information and asked for another number to call. Before hanging up they said, "Are you sure you don't want to take care of this bill now? It's due in X days"

I politely declined, they pushed further, and wouldn't stop "selling" me to pay the bill until I simply stated "I dispute the charge." They gave me the number to call and asked if I wanted to be automatically transferred. They then did one of those blackhole transfers where I get hung up on.
This is exactly what happens when doctors offices call insurance companies. Hard to find someone who can help, misinformation commonly given, and frequently get hung up on after being on hold for 30-60 minutes.
Yes. Such insurance companies, in my experience, deliberately have such lines staffed by folks that do not have a clue about anything medical or can explain or research anything.

Gill
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Re: Challenging a Late Medical Bill

Post by Gill » Wed May 17, 2017 8:20 pm

dm200 wrote:Unless someone can cite a reference, contrary to common belief, I do not believe there is a statute of limitations on paying or being obligated to pay a legitimate obligation in the past.

These kinds of things are very annoying, to say the least. Going back two years and having changed insurance, it can become very difficult to verify the legitimacy of such a bill.

What I would wonder about is whether this may have been somehow stuck in the provider and insurance process - that can go on for a long time.
Yes, there certainly is. The Statute limits the time judicial proceedings can be brought to enforce an obligation. It can very well be a legitimate obligation.
Gill
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toofache32
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Re: Challenging a Late Medical Bill

Post by toofache32 » Wed May 17, 2017 8:25 pm

an_asker wrote:
toofache32 wrote:[...]When I was an in-network doctor with insurance plans, my record was 18 months to get a claim adjudicated. Only after they finalized the claim was I able to know how much to bill the patient for their part. This was for a 10 hour surgery.[...]
PS: I am really curious - with a name like toofache, I thought you were a dentist (or oral surgeon). But I cannot think of oral surgery that can be 10 hours long. Or can it really get that long?!! :confused
I perform head and neck cancer surgery and reconstruction. I have developed a reconstructive surgery that only 3 other surgeons in the country have figured out how to do. Traditional techniques done everywhere else require multiple operations over a 12-18 month period to complete the reconstruction. I do it in a single 10-hour surgery. I am not in network with any medical insurance though. Relating back to this thread, I never send a late bill because payment is taken up front. My patients never have surprises.

mikep
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Re: Challenging a Late Medical Bill

Post by mikep » Thu May 18, 2017 8:18 am

Start with an explanation of benefits from your insurance company. It is possible that insurance won't pay anything since it is submitted long after services were rendered, but at least they can advise you what to do if you have a similar statute of limitations on payment.

staythecourse
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Re: Challenging a Late Medical Bill

Post by staythecourse » Thu May 18, 2017 8:29 am

Who cares what the hospital says you owe.

Wait until you get the EOB from the insurance company. If they tell you owe something that holds more validity.

Just tell the hospital you will address this when you get the EOB from your insurance before acting on it to make sure all the numbers are computed correct.

Good luck.

p.s. EOB is Explanation of Benifits, i.e. the letter you get from the insurance of the breakdown of charges.
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8foot7
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Re: Challenging a Late Medical Bill

Post by 8foot7 » Thu May 18, 2017 8:31 am

Gill wrote:
dm200 wrote:Unless someone can cite a reference, contrary to common belief, I do not believe there is a statute of limitations on paying or being obligated to pay a legitimate obligation in the past.

These kinds of things are very annoying, to say the least. Going back two years and having changed insurance, it can become very difficult to verify the legitimacy of such a bill.

What I would wonder about is whether this may have been somehow stuck in the provider and insurance process - that can go on for a long time.
Yes, there certainly is. The Statute limits the time judicial proceedings can be brought to enforce an obligation. It can very well be a legitimate obligation.
Gill
Typically the statute of limitation is three years for debts. Some states like Hawaii are longer. It doesn't de-legitimize the original debt, but as Gill says, it is grounds for automatic dismissal of any lawsuit brought to force payment. Creditors can still report to credit bureaus (at least until 7 years after the date of first delinquency) but essentially that's the only weapon a creditor has after the statute expires.

Da5id
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Re: Challenging a Late Medical Bill

Post by Da5id » Thu May 18, 2017 8:33 am

dm200 wrote:Unless someone can cite a reference, contrary to common belief, I do not believe there is a statute of limitations on paying or being obligated to pay a legitimate obligation in the past.

These kinds of things are very annoying, to say the least. Going back two years and having changed insurance, it can become very difficult to verify the legitimacy of such a bill.

What I would wonder about is whether this may have been somehow stuck in the provider and insurance process - that can go on for a long time.
I've had a previous insurer decline to pay for a bill initially issued over 6 months after the covered procedure (BC/BS), and I didn't have to pay it either. That was the negotiated deal with the provider. You can't use that to run out the clock if the initial bill comes before the deadline. But it seems very fair to me, as it gets really hard to fix (or remember for that matter) services that happened in the distant past, particularly if you have lots going on medically. It is particularly hard if you've changed insurers and they are billing 2 years later. That said, if you don't have such a deal as BC/BS negotiates I'm not sure where you stand in a dispute.

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dm200
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Re: Challenging a Late Medical Bill

Post by dm200 » Thu May 18, 2017 8:34 am

Typically the statute of limitation is three years for debts. Some states like Hawaii are longer. It doesn't de-legitimize the original debt, but as Gill says, it is grounds for automatic dismissal of any lawsuit brought to force payment. Creditors can still report to credit bureaus (at least until 7 years after the date of first delinquency) but essentially that's the only weapon a creditor has after the statute expires.
Can you cite a reference for such a statute of limitations? That is certainly not my understanding at all.

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8foot7
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Re: Challenging a Late Medical Bill

Post by 8foot7 » Thu May 18, 2017 8:40 am

dm200 wrote:
Typically the statute of limitation is three years for debts. Some states like Hawaii are longer. It doesn't de-legitimize the original debt, but as Gill says, it is grounds for automatic dismissal of any lawsuit brought to force payment. Creditors can still report to credit bureaus (at least until 7 years after the date of first delinquency) but essentially that's the only weapon a creditor has after the statute expires.
Can you cite a reference for such a statute of limitations? That is certainly not my understanding at all.
They are state specific. Here is my state: http://statelaws.findlaw.com/north-caro ... -laws.html
The law sections are noted.

pindevil
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Re: Challenging a Late Medical Bill

Post by pindevil » Thu May 18, 2017 8:48 am

Sounds like a common issue. We also received bills relating to our childs birth 2yrs after the fact. It's a pain but apparently there is no expiration date for a legitimate obligation.

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dm200
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Re: Challenging a Late Medical Bill

Post by dm200 » Thu May 18, 2017 8:55 am

8foot7 wrote:
dm200 wrote:
Typically the statute of limitation is three years for debts. Some states like Hawaii are longer. It doesn't de-legitimize the original debt, but as Gill says, it is grounds for automatic dismissal of any lawsuit brought to force payment. Creditors can still report to credit bureaus (at least until 7 years after the date of first delinquency) but essentially that's the only weapon a creditor has after the statute expires.
Can you cite a reference for such a statute of limitations? That is certainly not my understanding at all.
They are state specific. Here is my state: http://statelaws.findlaw.com/north-caro ... -laws.html
The law sections are noted.
These seem like lawsuits for injury, fraud, etc. and not just a normal debt obligation. What about just a common debt for sale of a product or providing a service?

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8foot7
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Re: Challenging a Late Medical Bill

Post by 8foot7 » Thu May 18, 2017 9:02 am

dm200 wrote:
8foot7 wrote:
dm200 wrote:
Typically the statute of limitation is three years for debts. Some states like Hawaii are longer. It doesn't de-legitimize the original debt, but as Gill says, it is grounds for automatic dismissal of any lawsuit brought to force payment. Creditors can still report to credit bureaus (at least until 7 years after the date of first delinquency) but essentially that's the only weapon a creditor has after the statute expires.
Can you cite a reference for such a statute of limitations? That is certainly not my understanding at all.
They are state specific. Here is my state: http://statelaws.findlaw.com/north-caro ... -laws.html
The law sections are noted.
These seem like lawsuits for injury, fraud, etc. and not just a normal debt obligation. What about just a common debt for sale of a product or providing a service?
From the link I posted.
Contracts Written: 3 yrs. §1-52(1); Oral: 3 yrs. §1-52(1)

Da5id
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Re: Challenging a Late Medical Bill

Post by Da5id » Thu May 18, 2017 9:07 am

You should see if your insurer has a timely billing policy. If they do, and the initial bill is from an in-network provider and is after that deadline, you may be entitled to not pay it. Worth investigating at least.

Not sure this is accurate/up to date but below is a list from here:
.
Below are some of the larger payers' timely filing deadlines — print this out and keep it handy:

• Medicare: 365 days from the date of service

• Blue Cross/Blue Shield: 365 days from the date of service

• Cigna: 90 days from the date of service

• Medicaid: 95 days from the date of service

• United Healthcare: 90 days from the date of service

• Health Net: 120 days from the date of service

• Secure Horizons: 90 days from the date of service

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