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WhatNow
Say Cheese!
Member since 1/06 8033 total posts
Name:
A (formerly WhatNow?)
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Question for those in Medical Billing, or just those who might now...
My husband just went to see a specialist he goes to see from time to time. Last time he went to him was about 3 months ago. When he was there today the person at front desk informed him that there is a bill for $1100 for a procedure he had done over 2 years ago. She said she actually called him and left a message about it and said that he needs to call their billing company.
There was never any message and we never received any bills. This is the first time we hear about this even though my husband been to this doctor several times between now and the time this bill charge supposedly occurred.
Further more, 2 years ago we had a completely different health insurance.
What should out course of action be? Why is is this being brought up now, all of sudden?
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Posted 4/10/16 3:25 PM  |
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alli3131
Peanut is here!!!!!!
Member since 5/09 18388 total posts
Name:
Allison
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Question for those in Medical Billing, or just those who might now...
First call the billing dept tomorrow and get more details.
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| Posted 4/10/16 4:48 PM |
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BlessedMomma
LIF Adult
Member since 12/11 6163 total posts
Name:
Momma Bear
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Question for those in Medical Billing, or just those who might now...
Sounds to me like a couple of different things could have possibly happened:
1. Your account fell through the cracks and they use a billing program that never sent out a bill. Until now.
2. They were appealing it continuously and finally received info (highly unlikely it would take 2 years of appealing.)
3. They had sent bills but never got to you (again unlikely since hes been to the dr within the time frame.
I would contact the billing dept and just ask why you are getting a bill? If they say o well the insurance comp didnt cover the procedure. I would respond with well that was 2 years ago, why werent we billed within the last 2 years?
based on that answer You can let them know that Claims must be submitted to an insurance carriers within 90-120 days from the date of service. If they did not submit a bill, this is not your responsibility and you will speak with a lawyer. If they did and they denied it, but never billed you again you will contact a lawyer. It is not your fault they did not submit a bill to you within a timely fashion for YOU to even appeal it.
Appeals to an insurance carrier after they send the first denial is anywhere between 30-90 days from the day of the denial (depending on the type of denial to the insurance carrier)
There are VERY specific time frames for EVERYTHING with insurance carriers to protect patients from this type of issue. They also have a limited amount of time to bill a patient for a service.
I would also contact your insurance carrier from back then to find out the reason for denial. If they ever submitted a claim. and you can file an official complaint against them as well IF they are trying to bill you for their error.
FM if you have any questions =)
Message edited 4/11/2016 11:13:00 AM.
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| Posted 4/11/16 11:09 AM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those in Medical Billing, or just those who might now...
There could be a lot of reasons why the bill is just coming to light. This is actually what I do and it happens daily. Feel free to PM me if you have specific questions.
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| Posted 4/13/16 10:20 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those in Medical Billing, or just those who might now...
Posted by BlessedMomma
Sounds to me like a couple of different things could have possibly happened:
1. Your account fell through the cracks and they use a billing program that never sent out a bill. Until now.
2. They were appealing it continuously and finally received info (highly unlikely it would take 2 years of appealing.)
3. They had sent bills but never got to you (again unlikely since hes been to the dr within the time frame.
I would contact the billing dept and just ask why you are getting a bill? If they say o well the insurance comp didnt cover the procedure. I would respond with well that was 2 years ago, why werent we billed within the last 2 years?
based on that answer You can let them know that Claims must be submitted to an insurance carriers within 90-120 days from the date of service. If they did not submit a bill, this is not your responsibility and you will speak with a lawyer. If they did and they denied it, but never billed you again you will contact a lawyer. It is not your fault they did not submit a bill to you within a timely fashion for YOU to even appeal it.
Appeals to an insurance carrier after they send the first denial is anywhere between 30-90 days from the day of the denial (depending on the type of denial to the insurance carrier)
There are VERY specific time frames for EVERYTHING with insurance carriers to protect patients from this type of issue. They also have a limited amount of time to bill a patient for a service.
I would also contact your insurance carrier from back then to find out the reason for denial. If they ever submitted a claim. and you can file an official complaint against them as well IF they are trying to bill you for their error.
FM if you have any questions =)
She never said the bill never went To the insurance company. Additionally, there are MANY plans where the filing deadline is ONE YEAR. Also, this most likely isn't a denial, more likely deductible or coinsurance. Denials do not become patient responsibility unless denied for a PATIENT related reason, such as the insurance requesting an injury questionnaire to be completed by the patient and it never being submitted.
The collections timeframe for NYS is 6 years, and there is no timeframe within that to get a bill out to a patient.
Wait until you speak with the billing dept tomorrow; find out what it was for, what the insurance did/said, etc. honestly, it's not likely going to be worth getting an atty involved unless they decide to take you to court if you refuse to pay.
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| Posted 4/13/16 10:27 PM |
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BlessedMomma
LIF Adult
Member since 12/11 6163 total posts
Name:
Momma Bear
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Question for those in Medical Billing, or just those who might now...
1 year for timely filing? I would love to know what plan that is. I worked in billing for a very long time and I have NEVER heard of this.
Regardless I have heard MANY times where smaller Drs offices try to take advantage of patients by billing them incorrectly for their own errors. Its not unheard of.
And I am sorry but there are time frames to get a bill out to patient. Ive fought this previously when a Drs office did it to me and my insurance told me I did not have to pay the bill the Dr was in the wrong and the Dr ended up writing it off.
I worked in a billing dept for many years for a large practice and there were times when accounts fell through the cracks and we had to write off balances because it passed timely filing and we could not bill a patient.
besides that I did tell her to call and confirm with the drs office AND insurance what is going on before taking any next steps.
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| Posted 4/14/16 9:06 PM |
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KaKa2323
Got my miracle
Member since 9/11 1465 total posts
Name:
K
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Re: Question for those in Medical Billing, or just those who might now...
Posted by BlessedMomma
1 year for timely filing? I would love to know what plan that is. I worked in billing for a very long time and I have NEVER heard of this.
Regardless I have heard MANY times where smaller Drs offices try to take advantage of patients by billing them incorrectly for their own errors. Its not unheard of.
And I am sorry but there are time frames to get a bill out to patient. Ive fought this previously when a Drs office did it to me and my insurance told me I did not have to pay the bill the Dr was in the wrong and the Dr ended up writing it off.
I worked in a billing dept for many years for a large practice and there were times when accounts fell through the cracks and we had to write off balances because it passed timely filing and we could not bill a patient.
besides that I did tell her to call and confirm with the drs office AND insurance what is going on before taking any next steps.
I've been in medical billing for 15 years and I will say not many insurances allow 1 year but there a few out there. We've definitely had a few times were something fell through the cracks and timely filing had past so the balance would have to be written off. But I've also had numerous occasions were I've fought with an insurance company to pay a bill for a year or so. In the end if they processed the bill a year later and patient had copay or deductible we are still entitled to bill for that as it was not our fault that insurance took so long to pay. And also if the insurance does take too long to pay a claim we are entitled to an extra fee simply because they took so long. I don't know what the exact situation was here, best bet is to call the insurance company. It's not uncommon for a lot of smaller insurances companies to take a long time to process a claim. It could take 3 months alone to get an original denial and then an additional 3 months and another 3 months for them to keep reprocessing claim incorrectly.
ETA I am actually in process of trying to get a Medicaid claim for 2014 paid still as of now. It was denied for bogus reasons. Not the norm but occasionally it happens
Message edited 4/15/2016 8:42:57 AM.
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| Posted 4/15/16 8:41 AM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those in Medical Billing, or just those who might now...
Posted by KaKa2323
Posted by BlessedMomma
1 year for timely filing? I would love to know what plan that is. I worked in billing for a very long time and I have NEVER heard of this.
Regardless I have heard MANY times where smaller Drs offices try to take advantage of patients by billing them incorrectly for their own errors. Its not unheard of.
And I am sorry but there are time frames to get a bill out to patient. Ive fought this previously when a Drs office did it to me and my insurance told me I did not have to pay the bill the Dr was in the wrong and the Dr ended up writing it off.
I worked in a billing dept for many years for a large practice and there were times when accounts fell through the cracks and we had to write off balances because it passed timely filing and we could not bill a patient.
besides that I did tell her to call and confirm with the drs office AND insurance what is going on before taking any next steps.
I've been in medical billing for 15 years and I will say not many insurances allow 1 year but there a few out there. We've definitely had a few times were something fell through the cracks and timely filing had past so the balance would have to be written off. But I've also had numerous occasions were I've fought with an insurance company to pay a bill for a year or so. In the end if they processed the bill a year later and patient had copay or deductible we are still entitled to bill for that as it was not our fault that insurance took so long to pay. And also if the insurance does take too long to pay a claim we are entitled to an extra fee simply because they took so long. I don't know what the exact situation was here, best bet is to call the insurance company. It's not uncommon for a lot of smaller insurances companies to take a long time to process a claim. It could take 3 months alone to get an original denial and then an additional 3 months and another 3 months for them to keep reprocessing claim incorrectly.
ETA I am actually in process of trying to get a Medicaid claim for 2014 paid still as of now. It was denied for bogus reasons. Not the norm but occasionally it happens
Thank you 
There are plenty of plans out there. Also, there are plans who would surprise you that will allow you to appeal a claim after a year (I actually did one from 2013 and won about 2 months ago for HIP). I'll also add that if they were pending and eventually denied the claim for COB information from the patient, once that info is received they would reprocess the claim, even years later. And if not, that ABSOLUTELY is patient responsibility, as the PATIENT failed to provide information to the insurance. Another example, we receive refund requests from BCBS going back 4+ years all the time, often times a result of an internal audit where they found the PATIENT defaulted on their premium (or in most cases the employer). No joke, these refund requests come in years later. Sometimes it'll be a refund request because they processed the claim without applying the proper deductible or coinsurance, and it's found after an internal audit. Happens ALL the time.... And guess what? Once we receive that info and refund paperwork from the insurance, you bet it's patient responsibility....
Do I agree with it all? No. As a patient will I work the system as best I can in my favor? You bet. But it's the insurance company's game and we just have to play it. Imagine the hell once Health Republic claims from last year finally get processed (or not). Who knows what'll happen at that point.
Oh and Medicare (probably one of the largest if not the largest plans) has a 1 year timely filing limit, and the. If there is secondary you can then submit to the secondary once you receive payment info. Also, there are plenty of valid reasons to appeal timely filing (I win those very often).
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| Posted 4/16/16 12:13 AM |
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