Medical bill received 4.5 years after service

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2pedals
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Re: Medical bill received 4.5 years after service

Post by 2pedals »

retiredjg wrote: Thu Jun 27, 2024 4:54 pm Even the IRS is still coming out from under a backlog generated in 2020. It should be no surprise that some medical billing went astray and some things that fell through the cracks are just now being rectified. I think we will be seeing more of these "late" bills.
I think some of the medical billing went astray even before 2020. I am sure it got worse for many providers. I would guess the providers who tried hard to recover from the crisis had fewer issues and wouldn't need or want to be in a position to bill several years later. In my case, the billing department was not honest about what happened and why we received a "FINAL STATEMENT" for services provided years ago (see my comment above). They said I was a "deadbeat" and didn't pay a bill that was sent 6 times and then sent to collections.
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Watty
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Re: Medical bill received 4.5 years after service

Post by Watty »

Something which may not have been mentioned.

The original service or at least the billing happened in 2020 when the pandemic was just hitting.

Many offices were shut down or at least in turmoil trying to figure out how to make things work, especially in the medical field.

That could be the root cause of the problem other than just incompetence.

If I was sure that it was a valid bill which I would have paid in 2020 if I had gotten a bill back then I would go on and just pay it even if you could somehow get out of it.
Marylander1
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Re: Medical bill received 4.5 years after service

Post by Marylander1 »

Watty wrote: Thu Jun 27, 2024 7:45 pm Something which may not have been mentioned.

If I was sure that it was a valid bill which I would have paid in 2020 if I had gotten a bill back then I would go on and just pay it even if you could somehow get out of it.
To those suggesting a bill should be paid 4.5 years after the pandemic hit, I have a question: is there any period after which you'd think sending an aged bill is no longer reasonable? How long is that?

I have left two medical bills unpaid among a great many in my lifetime: one was issued 19 months after the service (not during a global crisis) and when my insurance company said their policy was to reject bills more than one year old, I called the provider and said I had the same policy. I asked what their policy was for paying vendors who billed only years later, and they declined to answer. They were annoyed but agreed with my point and stopped sending that bill.

The other case was when specialist physician told me after an in-medical-network referral, "They completely ignored my orders, and this scan is useless. You'll have to get another scan. I wouldn't pay this bill." I appreciated that advice, and the second scan was useful.
JustGotScammed
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Re: Medical bill received 4.5 years after service

Post by JustGotScammed »

retiredjg wrote: Thu Jun 27, 2024 4:54 pm Is absolutely everyone, except bombcar, overlooking that this bill was probably being generated at the same time the COVID pandemic was declared?
  • Remember when everything in our world came to a halt?

    Nobody knew whether or how to go to work?

    Remote employment for ordinary jobs didn't exist yet?

    The entire medical profession was busy just trying to stay alive and figure out how people could say goodby to their dying loved ones by videochat?
Even the IRS is still coming out from under a backlog generated in 2020. It should be no surprise that some medical billing went astray and some things that fell through the cracks are just now being rectified. I think we will be seeing more of these "late" bills.

I don't know if there are any laws about when they can bill, but lots of deadlines get extended or paused during a crisis. This certainly seems to qualify. Even if there are some rules about this, they may not apply because of the enormity of the situation in this country during that time.
It's either a computer generated bill or it's not. If it's computer generated, it should have been sent timely. If it wasn't computer generated, then the reliability is in question.
HIinvestor
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Re: Medical bill received 4.5 years after service

Post by HIinvestor »

My insurer & Medicare refuses bills that aren’t timely submitted (I believe they have to be sent about 6 months after service). I don’t understand why I should pay a bill past that date as my insurer and Medicare wouldn’t oat their portions.

When I get a very late bill, I ask for a detailed billing and an explanation of why it’s so late. Often I’m told to just ignore it because they can’t provide any detail so long after the claimed service.
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8foot7
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Re: Medical bill received 4.5 years after service

Post by 8foot7 »

retiredjg wrote: Thu Jun 27, 2024 4:54 pm Is absolutely everyone, except bombcar, overlooking that this bill was probably being generated at the same time the COVID pandemic was declared?
  • Remember when everything in our world came to a halt?

    Nobody knew whether or how to go to work?

    Remote employment for ordinary jobs didn't exist yet?

    The entire medical profession was busy just trying to stay alive and figure out how people could say goodby to their dying loved ones by videochat?
Even the IRS is still coming out from under a backlog generated in 2020. It should be no surprise that some medical billing went astray and some things that fell through the cracks are just now being rectified. I think we will be seeing more of these "late" bills.

I don't know if there are any laws about when they can bill, but lots of deadlines get extended or paused during a crisis. This certainly seems to qualify. Even if there are some rules about this, they may not apply because of the enormity of the situation in this country during that time.
It turns out I don’t care. We all went through the same thing. Plenty of people were out of work entirely and didn’t have the opportunity to do work for which they could send a bill four years later. We all figured it out. My wife was pregnant with twins in a high-risk situation from February through October 2020 and somehow those bills, from labs and specialists alike, managed to get sent in time. Those providers dealt with it. The firm in OP’s question could have figured it out too.
EddyB
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Re: Medical bill received 4.5 years after service

Post by EddyB »

brian91480 wrote: Thu Jun 27, 2024 8:08 am Laws aside... Ethics dictate that you should pay for services that you receive.

Look at this situation as a plus:

You got to keep the $1,400 and collect interest and investment growth for 4 years... and you get you keep those profits. 👍

--- Brian
Ethics dictates that the service provider presents demands for payment in a timely fashion.
Parkinglotracer
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Re: Medical bill received 4.5 years after service

Post by Parkinglotracer »

bombcar wrote: Thu Jun 27, 2024 10:24 am Ask them if you can wait 4.5 years to pay!

(No joke I bet if you called and asked for a 0% plan to pay it off over 48 months they would say sure.)
Exactly.
I’d call them and discuss the situation. After I researched the contract / law.
EddyB
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Re: Medical bill received 4.5 years after service

Post by EddyB »

TomatoTomahto wrote: Thu Jun 27, 2024 9:07 am
mikep wrote: Thu Jun 27, 2024 7:56 am
This is a valid amount according to our explanation of benefits with our high deductible plan, and I noted in our HSA records that I was never billed for the service.
I believe that you answered your own question.

I only had a delayed bill once in our past. A bill arrived for a consultation during our son’s birth. We did not recognize the doctor’s name and had no honest idea why he would have consulted. I sent them a letter saying that, in the hubbub of delivery we had no idea if the bill was legitimate, and since our son was entering kindergarten, we considered the bill too late to be reasonable. They agreed and went away.
When I had to deal with US insurance, I only deeply scrutinized the EOB upon receiving a claim for some additional payment. If I received that claim only several years later, I would not be in remotely the same position to recall and address the situation.
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Cyan
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Re: Medical bill received 4.5 years after service

Post by Cyan »

Last week I received a bill from a health care service provider for an office visit from June 2022 (about 2 years ago). It was just a bill, with not much explanation of why I was being charged.

The bill was for approximately $230 (= office visit charge - copay paid at the time of the visit.)

When I called the health care service provider, they said the insurance company declined the claim. I called the insurance company and they said they never received a claim from the health care service provider.

But the insurance company representative kindly offered to call my health care service provider.

The insurance company inquiry found that the service provider made a clerical error with my insurance account information, so the claim was not filed in my name. It got resolved quickly at that point, and I no longer have a bill to pay.

A couple of suggestions from my experience.
  • Between the June 2022 office visit and when I received my bill 2 years later (now in June 2024), my employer changed health insurance providers. But, since I kept my old health insurance card, I had all the account information I needed to address the old claim with my old health insurance provider.
  • I also find it useful to keep a simple call log (in a Word document or spread sheet file) to record the time & date, length of call, who, and what was discussed for medical (or really, any customer service inquiry). It’s very helpful to be able refence time & dates, length of the call, who you talked to, and what was discussed when the next contact is made.
WonderWander
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Re: Medical bill received 4.5 years after service

Post by WonderWander »

I once received an invoice from a lab for some tests done almost 9 years ago. It wasn’t a huge amount but no way for me to remember whether it was legitimate or not. I just called the provider and told them they need to provide more details as I’m not paying a 9 year old bill out of the blue. For all I know, I probably already paid it but have no way to check after such a long time.

Customer rep put me on hold for a few and then told me the provider will cancel the invoice.
clip651
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Re: Medical bill received 4.5 years after service

Post by clip651 »

Cyan wrote: Fri Jun 28, 2024 2:58 pm Last week I received a bill from a health care service provider for an office visit from June 2022 (about 2 years ago). It was just a bill, with not much explanation of why I was being charged.

The bill was for approximately $230 (= office visit charge - copay paid at the time of the visit.)

When I called the health care service provider, they said the insurance company declined the claim. I called the insurance company and they said they never received a claim from the health care service provider.

But the insurance company representative kindly offered to call my health care service provider.

The insurance company inquiry found that the service provider made a clerical error with my insurance account information, so the claim was not filed in my name. It got resolved quickly at that point, and I no longer have a bill to pay.

A couple of suggestions from my experience.
  • Between the June 2022 office visit and when I received my bill 2 years later (now in June 2024), my employer changed health insurance providers. But, since I kept my old health insurance card, I had all the account information I needed to address the old claim with my old health insurance provider.
  • I also find it useful to keep a simple call log (in a Word document or spread sheet file) to record the time & date, length of call, who, and what was discussed for medical (or really, any customer service inquiry). It’s very helpful to be able refence time & dates, length of the call, who you talked to, and what was discussed when the next contact is made.
Thanks for sharing your experience. I've always kept old insurance cards for a few years at least. And I keep notes when I make customer service calls, but they are scattered all over on bits of paper or on the back of the bill I was calling about, etc. Great idea to keep a log of such calls in one spot. It would be searchable, too, which could help for old stuff.
WanderDad
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Re: Medical bill received 4.5 years after service

Post by WanderDad »

4.5 years, pandemic or not, is completely out of the realm of reasonable expectation. Automated billing or not, some sort of explanation is also merited.

If pandemic is the excuse, then the downtime of the pandemic could also mean this office incorrectly billed insurance. Heck, they may have been paid by insurance and are now double billing.

Maybe there’s a honest mistake. Or it could be an office playing fraud and seeing what they can get.

If the law is on your side in terms of billing timeframes, if it were me I’d be asking for line item statements and an explanation. I’d also be discussing it with my insurance company in case insurance had paid something out.

Medical billing is so convoluted and messed up, it doesn’t get to demand blind trust from a customer, especially for something billed so long after service.
lazynovice
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Re: Medical bill received 4.5 years after service

Post by lazynovice »

I was involved with medical billing for decades including during the pandemic. Anything older than two years never went to a patient.

What I don’t understand is why your insurance company has not denied this for lack of timely filing. If they issued a valid EOB, it sounds like the bill was sent timely to the insurance company but maybe your portion was not sent to you timely. Insurance contracts almost universally require a bill within 365 days AT THE LATEST. Some are 90 and some are 180.

I’d call to ask why you are just now getting the bill. They owe an explanation. And then I would escalate through the chain of command for a courtesy write off. But I have a lot of time on my hands.

Having been on the other side, I can tell you that we would have considered it unethical to bill a patient that far past the date of service.
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Regal 56
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Re: Medical bill received 4.5 years after service

Post by Regal 56 »

I’m stunned that anyone defends sending a bill 4.5 years after service. As someone pointed out, would a business that sends a timely bill be okay with a customer who waits 4.5 years to pay? Of course not. So why is it okay for a business to be ridiculously late in sending a bill? As has also been pointed out, the health industry and insurance companies have saddled us with a befuddling billing system that no normal person can understand. It’s unreasonable to expect patients to know exactly what they’ll pay out of pocket—it’s equally unreasonable to expect patients to keep tabs on whether or not a bill will be coming to them.

Our health care system has created a billing procedure chock full of conditions, exclusions, and exceptions that rival a Kafka novel. Even those who work daily within this system have trouble understanding it. Perhaps if more people refused to quietly acquiesce to this ludicrously arcane system, it would change. Were I the OP, I’d at least make myself a nuisance to the late biller. Their behavior deserves no less.
Normchad
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Re: Medical bill received 4.5 years after servi

Post by Normchad »

Regal 56 wrote: Sat Jun 29, 2024 9:51 pm I’m stunned that anyone defends sending a bill 4.5 years after service. As someone pointed out, would a business that sends a timely bill be okay with a customer who waits 4.5 years to pay? Of course not. So why is it okay for a business to be ridiculously late in sending a bill? As has also been pointed out, the health industry and insurance companies have saddled us with a befuddling billing system that no normal person can understand. It’s unreasonable to expect patients to know exactly what they’ll pay out of pocket—it’s equally unreasonable to expect patients to keep tabs on whether or not a bill will be coming to them.

Our health care system has created a billing procedure chock full of conditions, exclusions, and exceptions that rival a Kafka novel. Even those who work daily within this system have trouble understanding it. Perhaps if more people refused to quietly acquiesce to this ludicrously arcane system, it would change. Were I the OP, I’d at least make myself a nuisance to the late biller. Their behavior deserves no less.
You’re correct, of course.

Medical billing is a special thing ,and not in a good way. I’m a “ pay all your bills” kind of person. Generally, I pay everything in full the day I receive it.

But not medical bills. I generally ignore them the first time they show up. I honestly believe their business model is just to flood the world with bills, and if some people pay, great. I don’t think they even expect to be paid for a lot of these. So I wait for the second bill to come in the mail. Often, they don’t.

I’ve written here before about a medical billing problem I was having. It took 2 full years to resolve. And it never really got resolved correctly. My insurance company should have paid it. But the way it eventually resolved is,the final time I called the medical provider,they said “you don’t owe anything”, and when I asked why, they just said, “we wrote it off”.

Anyway, the whole thing is very screwed up. And on top,of that, we all know the “billed amount” bears no resemblance to reality. I.e. it doesn’t match “reasonable and customary” or whatever they call it. We billed $2,700, but the agreed to rate with insurance is $115, etc. so yeah, nobody is really paying that “billed amount” anyway…..

I bet if this thread were about a bill from some other type of service, perhaps a roofer, the responses would be a little different. If a roofer called me 3.5 years later, and explained they forget to bill the full amount, and I confirmed they were correct, I’d pay them that day. But medical bills, nah, they can pound it.
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bottlecap
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Re: Medical bill received 4.5 years after service

Post by bottlecap »

I wouldn’t pay. They waited too long and that money is already spent. If you knew you owed it four years ago and didn’t try to correct it with them, I’d feel differently. Surprise billing four years later? No.

This is not an ethical issue on your part. It may be on their part. They need to send a bill in a reasonable time with respect to the service. That's what is presumed in any agreement.

JT
Sandwich
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Re: Medical bill received 4.5 years after service

Post by Sandwich »

Had a similar situation happen to me.

Invoice in Fall, 2023 for co-pays for visits (<<< $ 100) right before Covid .... that's .. 3.5 years late. :annoyed

I sent a check for the co-pays ... I am under the impression that a healthcare provider sending a claim that late would have less luck getting a positive response from an insurance company.
JackoC
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Re: Medical bill received 4.5 years after service

Post by JackoC »

8foot7 wrote: Thu Jun 27, 2024 4:10 pm
bd7 wrote: Thu Jun 27, 2024 11:10 am The main thing I'd want to know is whether this is one of those lab bills for more or less normal blood work that the insurance company might typically pay less than $100 for but when they don't cover it, the lab bills you for 10X that or more.
This is an important point. If the bill were for under $100 for lab work and I knew the service was performed, I'd grumble but send a check. For $1,400 on services over four years ago that may have a 1,300% markup included, very much the opposite.
This is the basic reason 'you bought the service, ethics demand you pay in full' breaks down for most medical bills. When I agree to pay a particular amount, rate per hr or unit etc. and a service is delivered satisfactorily I feel I must pay, legalities aside. But with medical bills you are usually actively discouraged if not outright prevented from determining a price when you agree to the service. There are exceptions to that rule (in which case back to the first point) but that's the rule. Which makes it nonsensical (or appear self interested depending) to simply say 'you got the service, pay (whatever they say, whenever they get around to billing you)'.

I once got an EOB saying I'd be charged $10k, that's right, as a facility fee for an endoscopy on top of the Dr's fee, and OON: insurance wouldn't pay. At a facility the Dr told me didn't charge one. There was something odd going on with her, not the only episode, we did pay her bill but dropped her. But for whatever reason that facility never sent a bill (10yrs+, I paid a similar all-in amount to this Dr's fee alone on a subsequent endoscopy with somebody else). But if they had, would I really have needed to pay in full no questions asked to avoid 'unethical behavior'? I can't take that position seriously.
snic
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Re: Medical bill received 4.5 years after service

Post by snic »

BrooklynInvest wrote: Thu Jun 27, 2024 2:49 pm I think my son was 2 before we straightened out the billing for his birth.

Granted they sent the first bill a few days after he was born. The rest of the two years was me asking them 50+ times to bill the correct amount.

Wasn't like I could return the purchase...
We were lucky to have great insurance when our daughter was born. The only out-of-pocket medical expense for the entire process (prenatal visits to pediatrician follow-up) was a $5 copay that was probably charged in error. So of course for the last two decades her mom has been joshing her with, "I'm gonna return you and get my $5 back!" (Usually after we ask her to do something and she refuses.)
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yankees60
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Re: Medical bill received 4.5 years after service

Post by yankees60 »

snic wrote: Tue Jul 09, 2024 11:00 am
BrooklynInvest wrote: Thu Jun 27, 2024 2:49 pm I think my son was 2 before we straightened out the billing for his birth.

Granted they sent the first bill a few days after he was born. The rest of the two years was me asking them 50+ times to bill the correct amount.

Wasn't like I could return the purchase...
We were lucky to have great insurance when our daughter was born. The only out-of-pocket medical expense for the entire process (prenatal visits to pediatrician follow-up) was a $5 copay that was probably charged in error. So of course for the last two decades her mom has been joshing her with, "I'm gonna return you and get my $5 back!" (Usually after we ask her to do something and she refuses.)
!!!!!!!!!!
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
Skip Towne
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Re: Medical bill received 4.5 years after service

Post by Skip Towne »

The medical provider provided you the requested/required services in February 2020.

Shortly after the service was provided and before billing could occur, the medical industry experienced total and complete pandemic pandemonium. While they trying to save lives, cope with dying employees, figure out work-from-home for secure systems like billing, they failed to send a timely invoice. As I recall, CA "shut down" early March.

The expense is valid and you know you never paid.

You had the benefit of holding the money all this time.

Sorry, but I fail to understand the questions about ways to rationalize not paying $1400 for service rendered. If I had the means to pay the invoice, I'd be happy to do so in 2024 dollars.
scophreak
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Re: Medical bill received 4.5 years after service

Post by scophreak »

Skip Towne wrote: Tue Jul 09, 2024 9:07 pm The medical provider provided you the requested/required services in February 2020.

Shortly after the service was provided and before billing could occur, the medical industry experienced total and complete pandemic pandemonium. While they trying to save lives, cope with dying employees, figure out work-from-home for secure systems like billing, they failed to send a timely invoice. As I recall, CA "shut down" early March.

The expense is valid and you know you never paid.

You had the benefit of holding the money all this time.

Sorry, but I fail to understand the questions about ways to rationalize not paying $1400 for service rendered. If I had the means to pay the invoice, I'd be happy to do so in 2024 dollars.
I think the question has been framed a bit differently (specifically so by one prior poster). There isn't necessarily a dispute regarding the amount of the bill, though at this point in time it is significantly harder to remember and/or prove the details of the visit after 4.5 years. Instead, the entire discussion here revolves around the elapsed time since the visit. Yes, there are some extenuating circumstances but that only takes us so far. Presumably, there is an amount of time that you might consider it unreasonable to send such a retroactive invoice. This thread has already covered that contractually that period is often 365 days (or much less) for insurance companies to consider the claim. Why wouldn't similar logic apply to the patient? If it does apply, then what amount of elapsed time would be UNreasonalbe? 1 year, 2 years, 5 years, 10 years later? Why not 25 or 50 years later? There HAS to be some type of limit, right?
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8foot7
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Re: Medical bill received 4.5 years after service

Post by 8foot7 »

Skip Towne wrote: Tue Jul 09, 2024 9:07 pm

Shortly after the service was provided and before billing could occur, the medical industry experienced total and complete pandemic pandemonium. While they trying to save lives, cope with dying employees, figure out work-from-home for secure systems like billing, they failed to send a timely invoice. As I recall, CA "shut down" early March.

It wasn't just the medical industry that experienced "total and complete pandemic pandemonium" and every other industry figured out how to provide service and receive revenue without waiting 4.5 years for it. Even many -- perhaps even most -- medical providers figured it out during the "total and complete pandemic pandemonium" as numerous posters have attested to receiving medical bills during 2020. Spare us the small violin song.
TropikThunder
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Re: Medical bill received 4.5 years after service

Post by TropikThunder »

Skip Towne wrote: Tue Jul 09, 2024 9:07 pm Shortly after the service was provided and before billing could occur, the medical industry experienced total and complete pandemic pandemonium. While they trying to save lives, cope with dying employees, figure out work-from-home for secure systems like billing, they failed to send a timely invoice.
Give me a break. The one thing they figured out how to do immediately was get paid. Besides, most medical billing was already being done by third parties whose employees already worked remotely.
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bd7
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Re: Medical bill received 4.5 years after service

Post by bd7 »

Skip Towne wrote: Tue Jul 09, 2024 9:07 pm The expense is valid and you know you never paid.
The OP has not responded so we don't know whether the expense is valid or not, and nobody does unless we have the EOB and the itemized lab bill. Routine labwork almost never costs $1400, but if they miscode it and the insurance company rejects it as not covered, then you might get ridiculous bill for 10X or more what would have been allowed if the tests were covered.

If the delay in receiving the bill resulted in the OP not being able to collect from the insurance company or to have the bill adjusted to the allowed amount, then he shouldn't have to pay it and that applies to both legal and moral arguments and without regard to who originally made the error that resulted in rejection if that is what happened. So without some more details, there isn't even a good ethical case to be made that the OP should just fork over the $1400 and be happy to have collected the interest in the meantime.
rbd789
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Re: Medical bill received 4.5 years after service

Post by rbd789 »

bd7 wrote: Wed Jul 10, 2024 10:01 am
Skip Towne wrote: Tue Jul 09, 2024 9:07 pm The expense is valid and you know you never paid.
The OP has not responded so we don't know whether the expense is valid or not, and nobody does unless we have the EOB and the itemized lab bill. Routine labwork almost never costs $1400, but if they miscode it and the insurance company rejects it as not covered, then you might get ridiculous bill for 10X or more what would have been allowed if the tests were covered.

If the delay in receiving the bill resulted in the OP not being able to collect from the insurance company or to have the bill adjusted to the allowed amount, then he shouldn't have to pay it and that applies to both legal and moral arguments and without regard to who originally made the error that resulted in rejection if that is what happened. So without some more details, there isn't even a good ethical case to be made that the OP should just fork over the $1400 and be happy to have collected the interest in the meantime.
The second and third sentences in the OP literally state the charge is valid according to the EOB. What's wrong with paying this charge, after collecting over four years of extra interest, in 2024 dollars?
Broken Man 1999
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Re: Medical bill received 4.5 years after service

Post by Broken Man 1999 »

bd7 wrote: Wed Jul 10, 2024 10:01 am
Skip Towne wrote: Tue Jul 09, 2024 9:07 pm The expense is valid and you know you never paid.
The OP has not responded so we don't know whether the expense is valid or not, and nobody does unless we have the EOB and the itemized lab bill. Routine labwork almost never costs $1400, but if they miscode it and the insurance company rejects it as not covered, then you might get ridiculous bill for 10X or more what would have been allowed if the tests were covered.

If the delay in receiving the bill resulted in the OP not being able to collect from the insurance company or to have the bill adjusted to the allowed amount, then he shouldn't have to pay it and that applies to both legal and moral arguments and without regard to who originally made the error that resulted in rejection if that is what happened. So without some more details, there isn't even a good ethical case to be made that the OP should just fork over the $1400 and be happy to have collected the interest in the meantime.
OP says in first post: "...This is a valid amount according to our explanation of benefits with our high deductible plan, and I noted in our HSA records that I was never billed for the service..."

Question: When was EOB received?

Most of my medical bills are co-pays, some doctors are slower than others concerning bills. I monitor my EOBs as I don't want to suddenly be surprised by a contact attempting to collect an overdue payment of one sort or another. My EOBs show my portion of charges, so I know the amount due whether I receive a bill or not.

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“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
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bd7
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Re: Medical bill received 4.5 years after service

Post by bd7 »

Broken Man 1999 wrote: Wed Jul 10, 2024 10:42 am OP says in first post: "...This is a valid amount according to our explanation of benefits with our high deductible plan, and I noted in our HSA records that I was never billed for the service..."
Yes, but he does not explain how he arrived at the conclusion that the bill was "valid", EOBs do not use that term. What they do use is the term "patient responsibility".

Here's an example that I'm dealing with currently. I saw my PCP on June 12 and he billed the insurance for $282. I noticed a claim in my insurance for this (I get notifications) that was deemed "out of network" and listed my patient responsibility as $282. I then got a bill for $282 from the providers billing service. I called them and they noted that there was an error, they were indeed still in network and they put a note on the account to hold collection efforts until they resolved it. Yesterday I got a bill showing an in-network adjustment of -$175, leaving me with a balance of $107 subject to the deductible. However, believing my deductible has been meet, I checked the insurance website and found a revised EOB stating that the in-network adjustment was $169, my deductible has been met so the patient responsibility is zero and they've already issued a payment of $113 to the provider. Nice little mess, eh? :shock:

Now my little saga has only happened over a 30-day period. Imagine just receiving that initial EOB, assuming that the stated patient responsibility was "valid" and then not getting the first bill until 4 years later. Would I be able to sort out what are multiple clear errors? Should I have to? When someone asks me about a situation like this, at the very least I would try to fully understand the situation and ask for more information where needed. So for the OP, the question is "why do you think the bill is valid?" In my experience there's a very good chance that it isn't and wasn't.
lazynovice
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Re: Medical bill received 4.5 years after service

Post by lazynovice »

Skip Towne wrote: Tue Jul 09, 2024 9:07 pm The medical provider provided you the requested/required services in February 2020.

Shortly after the service was provided and before billing could occur, the medical industry experienced total and complete pandemic pandemonium. While they trying to save lives, cope with dying employees, figure out work-from-home for secure systems like billing, they failed to send a timely invoice. As I recall, CA "shut down" early March.

The expense is valid and you know you never paid.

You had the benefit of holding the money all this time.

Sorry, but I fail to understand the questions about ways to rationalize not paying $1400 for service rendered. If I had the means to pay the invoice, I'd be happy to do so in 2024 dollars.
Because elective procedures were halted or slowed for several months in 2020, the billing offices had an excellent opportunity to catch up on any backlogs created by the couple of week delay of getting office based employees remote. And many providers used home based employees pre-pandemic anyway. Many used off shore employees so depending upon when COVID hit India, the Philippines etc. the backlog time period varied.
JackoC
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Re: Medical bill received 4.5 years after service

Post by JackoC »

bd7 wrote: Wed Jul 10, 2024 10:01 am
Skip Towne wrote: Tue Jul 09, 2024 9:07 pm The expense is valid and you know you never paid.
The OP has not responded so we don't know whether the expense is valid or not, and nobody does unless we have the EOB and the itemized lab bill. Routine labwork almost never costs $1400, but if they miscode it and the insurance company rejects it as not covered, then you might get ridiculous bill for 10X or more what would have been allowed if the tests were covered.

If the delay in receiving the bill resulted in the OP not being able to collect from the insurance company or to have the bill adjusted to the allowed amount, then he shouldn't have to pay it and that applies to both legal and moral arguments and without regard to who originally made the error that resulted in rejection if that is what happened. So without some more details, there isn't even a good ethical case to be made that the OP should just fork over the $1400 and be happy to have collected the interest in the meantime.
I agree. IMO the simple principal of 'pay for what you received' can't ever be blindly applied to a system that works so hard to prevent price transparency upfront. Does it mean don't pay medical bills? No. But it means IMO no presumption that negotiating a medical bill with pricing disclosed only after the fact is 'unethical'. You contracted somebody for $2k in painting $1k upfront, $1k on satisfactory completion. Completion is in fact satisfactory but you offer $500 on a bogus pretext hoping they'll knuckle under: unethical IMO. But there's categorically no ethical issue IMO with trying to negotiate prices you only get to learn after the fact. That would include such a long billing delay as we were told, and I agree with your implication that assuming the $1400 is a reasonable price has no real basis either. OP didn't specifically say so, but super high 'list prices' providers virtually never get paid in full appear on medical bills all the time. Is it worth it practically to contest bills? In many cases not, but that's a practical not ethical or legal issue.
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Re: Medical bill received 4.5 years after service

Post by nonnie »

I don't know if it is still as prevalent as it used to be but in the past doctors got together, formed LLCs and then opened-- MRI/diagnostic Imaging centers and surgery centers. In the earlier days of MRIs, there sometimes would only be one available in a city. These days many physician practices have added lab diagnostic services.

There was a law passed in 2010 requiring ownership disclosure by referring physicians.

One only has to look at Medicare reimbursement rates for lab tests (which I think are too low but...) to see how wildly inflated private pay billed lab rates are. If not covered by insurance, one should always ask for the insurance "contracted" rate.
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Re: Medical bill received 4.5 years after service

Post by skepticalobserver »

You may be passed limitations, but you don’t know what you don’t know (about the law). Regardless, that will not stop posting this problem with one or more of the credit reporting agencies or a bill collectors’ phone calls. If the bill is legit work out a compromise—and get it in writing.
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Re: Medical bill received 4.5 years after service

Post by JackoC »

skepticalobserver wrote: Thu Jul 11, 2024 8:27 am You may be passed limitations, but you don’t know what you don’t know (about the law). Regardless, that will not stop posting this problem with one or more of the credit reporting agencies or a bill collectors’ phone calls. If the bill is legit work out a compromise—and get it in writing.
For credit agencies I'd note they've stopped including outstanding medical debt of <$500 last year. It might be relevant to the amount to offer the provider v the full $1400. It's still not IMO 100% crystal clear how this works, but the straightforward implication would be that if you pay $900+ on a $1400 bill, despite not reaching agreement with the provider that that entirely settles it, they would be able to send the remainder it to a bill collector but not the credit agencies. I'd welcome being corrected by definitive info otherwise. And note I'm not talking about (off topic) very recent proposal of government action on credit reports and medical bills, but the practice the agencies themselves already adopted.
https://www.consumerfinance.gov/about-u ... it-report/

I'd reiterate that simply refusing to pay probably isn't the answer. But there is never IMO an 'ethical' issue with negotiating a medical bill where you didn't agree to the $ amount (or some billing rate per unit or hour etc) upfront. Where you agreed on price upfront, I'd say pay what you agreed, if the service was provided satisfactorily. But where there was no price agreed upfront (vast majority of medical bills in US system), there's an implicit agreement by the provider that the later provided price should be reasonable, including reasonably fair v what they collect for the same service in other cases, and billed within a reasonable period. That's a matter of opinion based on specific sets of facts case by case. A supposed ethical prohibition on the patient negotiating the price just because the service was already provided has no validity IMO.
Last edited by JackoC on Thu Jul 11, 2024 9:54 am, edited 1 time in total.
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Re: Medical bill received 4.5 years after service

Post by JackoC »

duplicate
ilisira
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Re: Medical bill received 4.5 years after service

Post by ilisira »

My biggest problem with a medical bill coming this late is, it’s outside the FSA window, and OP might have some funds in FSA that expired as the bill was not presented on time.

This happened to me once, and bill was presented ~6 months too late, and medical provider was OK to drop the bill significantly.
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Re: Medical bill received 4.5 years after service

Post by Broken Man 1999 »

bd7 wrote: Wed Jul 10, 2024 11:28 am
Broken Man 1999 wrote: Wed Jul 10, 2024 10:42 am OP says in first post: "...This is a valid amount according to our explanation of benefits with our high deductible plan, and I noted in our HSA records that I was never billed for the service..."
Yes, but he does not explain how he arrived at the conclusion that the bill was "valid", EOBs do not use that term. What they do use is the term "patient responsibility".

Here's an example that I'm dealing with currently. I saw my PCP on June 12 and he billed the insurance for $282. I noticed a claim in my insurance for this (I get notifications) that was deemed "out of network" and listed my patient responsibility as $282. I then got a bill for $282 from the providers billing service. I called them and they noted that there was an error, they were indeed still in network and they put a note on the account to hold collection efforts until they resolved it. Yesterday I got a bill showing an in-network adjustment of -$175, leaving me with a balance of $107 subject to the deductible. However, believing my deductible has been meet, I checked the insurance website and found a revised EOB stating that the in-network adjustment was $169, my deductible has been met so the patient responsibility is zero and they've already issued a payment of $113 to the provider. Nice little mess, eh? :shock:

Now my little saga has only happened over a 30-day period. Imagine just receiving that initial EOB, assuming that the stated patient responsibility was "valid" and then not getting the first bill until 4 years later. Would I be able to sort out what are multiple clear errors? Should I have to? When someone asks me about a situation like this, at the very least I would try to fully understand the situation and ask for more information where needed. So for the OP, the question is "why do you think the bill is valid?" In my experience there's a very good chance that it isn't and wasn't.
An EOB is important to me because of two things: It will tell me my responsibility (if any) and at least for me I want my providers to get paid. 99% of the time I am only responsible for a co-pay. I don't have to worry where we are in deductibles because our MA plan has no medical or pharmacy deductibles.

Thus, if the OP's EOB had been received after the lab services were done, at the very least I would see that as a trigger to BOLO for a bill. Me, I hate outstanding bills. There is no way I would not check for an outstanding bill if my EOB showed any responsibility. Some docs I use collect the co-pay at my appointment, others bill me. Those doc's EOBs who bill me are in a file I run thru periodically.

So, OP knew the bill was legit (HIS determination), and COULD have made an attempt to get a bill sent so he could have paid for the services received.

That is why I asked when the EOB was available to OP.

Broken Man 1999
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Re: Medical bill received 4.5 years after service

Post by Regal 56 »

JackoC wrote: IMO the simple principal of 'pay for what you received' can't ever be blindly applied to a system that works so hard to prevent price transparency upfront. Does it mean don't pay medical bills? No. But it means IMO no presumption that negotiating a medical bill with pricing disclosed only after the fact is 'unethical'. You contracted somebody for $2k in painting $1k upfront, $1k on satisfactory completion. Completion is in fact satisfactory but you offer $500 on a bogus pretext hoping they'll knuckle under: unethical IMO. But there's categorically no ethical issue IMO with trying to negotiate prices you only get to learn after the fact. That would include such a long billing delay as we were told, and I agree with your implication that assuming the $1400 is a reasonable price has no real basis either. OP didn't specifically say so, but super high 'list prices' providers virtually never get paid in full appear on medical bills all the time. Is it worth it practically to contest bills? In many cases not, but that's a practical not ethical or legal issue.
I monitor all medical bills incurred by my Mother. Last week I received a bill for an April emergency room visit. I was about to pay it when I recalled that I’d already paid a bill for this same service. So I called the provider to ask about it. Turns out I had indeed already paid—the new bill was an error. This isn’t the first time I’ve encountered double billing for medical expenses. Providers often get it wrong. That’s the result of our incredibly inscrutable medical billing system. In my opinion, routinely challenging every medical bill is a perfectly rational response. I see nothing unethical about treating our Rube Goldberg system with default suspicion. They’ve earned it.
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Re: Medical bill received 4.5 years after service

Post by yankees60 »

Regal 56 wrote: Wed Jul 17, 2024 8:28 am
JackoC wrote: IMO the simple principal of 'pay for what you received' can't ever be blindly applied to a system that works so hard to prevent price transparency upfront. Does it mean don't pay medical bills? No. But it means IMO no presumption that negotiating a medical bill with pricing disclosed only after the fact is 'unethical'. You contracted somebody for $2k in painting $1k upfront, $1k on satisfactory completion. Completion is in fact satisfactory but you offer $500 on a bogus pretext hoping they'll knuckle under: unethical IMO. But there's categorically no ethical issue IMO with trying to negotiate prices you only get to learn after the fact. That would include such a long billing delay as we were told, and I agree with your implication that assuming the $1400 is a reasonable price has no real basis either. OP didn't specifically say so, but super high 'list prices' providers virtually never get paid in full appear on medical bills all the time. Is it worth it practically to contest bills? In many cases not, but that's a practical not ethical or legal issue.
I monitor all medical bills incurred by my Mother. Last week I received a bill for an April emergency room visit. I was about to pay it when I recalled that I’d already paid a bill for this same service. So I called the provider to ask about it. Turns out I had indeed already paid—the new bill was an error. This isn’t the first time I’ve encountered double billing for medical expenses. Providers often get it wrong. That’s the result of our incredibly inscrutable medical billing system. In my opinion, routinely challenging every medical bill is a perfectly rational response. I see nothing unethical about treating our Rube Goldberg system with default suspicion. They’ve earned it.
Good response with excellent example.
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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Re: Medical bill received 4.5 years after service

Post by sport »

Regal 56 wrote: Wed Jul 17, 2024 8:28 am
JackoC wrote: IMO the simple principal of 'pay for what you received' can't ever be blindly applied to a system that works so hard to prevent price transparency upfront. Does it mean don't pay medical bills? No. But it means IMO no presumption that negotiating a medical bill with pricing disclosed only after the fact is 'unethical'. You contracted somebody for $2k in painting $1k upfront, $1k on satisfactory completion. Completion is in fact satisfactory but you offer $500 on a bogus pretext hoping they'll knuckle under: unethical IMO. But there's categorically no ethical issue IMO with trying to negotiate prices you only get to learn after the fact. That would include such a long billing delay as we were told, and I agree with your implication that assuming the $1400 is a reasonable price has no real basis either. OP didn't specifically say so, but super high 'list prices' providers virtually never get paid in full appear on medical bills all the time. Is it worth it practically to contest bills? In many cases not, but that's a practical not ethical or legal issue.
I monitor all medical bills incurred by my Mother. Last week I received a bill for an April emergency room visit. I was about to pay it when I recalled that I’d already paid a bill for this same service. So I called the provider to ask about it. Turns out I had indeed already paid—the new bill was an error. This isn’t the first time I’ve encountered double billing for medical expenses. Providers often get it wrong. That’s the result of our incredibly inscrutable medical billing system. In my opinion, routinely challenging every medical bill is a perfectly rational response. I see nothing unethical about treating our Rube Goldberg system with default suspicion. They’ve earned it.
I keep a spreadsheet for all medical claims. It shows the date of service, the provider, the type of service, the amount billed, the amount paid by insurance, the amount I need to pay, the amount I have paid, and the check/transaction number for the payment. It may sound complicated, but it only takes a minute to add entries to the spreadsheet. As a result, I know exactly the status of each medical claim whenever a question arises.
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