How long does a doctor have to file an insurance claim?
Have you contacted the doctor's office to make sure they have your correct insurance information? If they don't have the correct insurance information on file for you, then they can't file a claim. So, generally the provider's office will send the bill to you hoping that it gets you to call the office. (On average, patients don't tend to return phone calls asking for insurance information. So, its pretty standard to just mail a bill...it gets their attention.) You need to find out what the claims filing limit is for your insurance policy...it can range anywhere from 6 months to a year, generally. If you're still within the filing limit, then you need to make sure the doctor's office has what they need to file the claim. If its past the filing limit, a doctor who has a contract with your insurer will usually have to write off the bill (unless they can prove that the patient was at fault for not providing accurate insurance info). If the doctor does not have a contract with your insurance company, there's nothing stopping them from billing you for the entire service. But you definitely need to call the doctor's office and your insurance company to confirm exactly what the issue is here.
Medical Bill received over a year later- do I have any recourse?
Generally speaking, in the end it’s considered the patient’s responsibility to make sure that all medical bills are submitted to the health insurance company for reimbursement. However, the process is complicated and largely in the hands of medical providers, so things like this can happen. When they do happen, it stinks. To summarize the problem as I understand it, the auto insurer paid a portion of your medical bill. The remainder should have been submitted to your health insurance company, but the medical provider was slow to do so. When they finally did, the claim was denied because it wasn’t submitted in a timely manner. Now the doctor’s office is billing you for what was really their oversight. Here’s what I’d recommend: First, contact your health insurance provider, explain the situation step by step, and ask if they will make an exception and process the claim despite the fact that it was late. They may be more inclined to do so if you – rather than the doctor’s office – ask them to. If they won’t process the claim when submitted by the doctor’s office, ask them if you can pay the bill to the doctor’s office and then submit the claim to your insurer yourself. They may be willing to reimburse you directly. Finally – ask your insurer if the doctor’s office is in-network and, if so, if they’re contractually allowed to bill you like this. If they’re an in-network provider, they may have been contractually obligated to submit the bill for you in a timely manner. If they failed to do so, they may be contractually obligated NOT to bill you for it, but just to eat the loss. If none of these options works, well, then I’m afraid I can only recommend that you pay the bill yourself. Otherwise, you’ll likely get sent to collections, it could affect your credit, and it would probably be more trouble taking it to court than it’s worth. In the end, if the doctor’s office isn’t contractually prevented from billing you for a claim they were late to submit, the charge likely becomes your responsibility by law, since services were rendered to you. Best wishes.
How do I go to the doctor without my insurance card?
Sometimes the doctor's office can call the insurance carrier and confirm that you are covered, even if you don't have the card yet.
Can a doctor bill me over a year after my appointment?
MSAD has obviously never dealt with insurance contracts - every single one of them has a timely filing provision. The industry standard used to be 12 months from the date of service, but some companies are even moving to shorter time frames. We work with several insurers who won't accept claims more than 180 days from the date of service. If the provider is contracted with your insurance company, most likely they are obligated to write off the charge. Check with your insurer and/or refer to your Explanation of Benefits to be sure. **However** if your doctor was unable to file the claim within 12 months because of a delay on your behalf...say, because you didn't provide the doctor with complete and/or accurate insurance information...then the doctor may still be able to bill you anyhow. I would definitely call your insurer and ask whether you should be getting billed by the doctor - if the charges are something that the doctor should write off, then your insurer should be able to tell you that and possibly send a notice to the provider reminding him that he shouldn't be billing you.