Help a Reader: Late Doctor Bill

Here's an email I recently received from a reader:

I went to the Doctor's office in October of 2007.

In July of 2008 (9 months later) I received a bill for $92 with a note saying "Insurance No Longer Valid"

I had switched health insurance companies in May of 2007, so I mailed a copy of my insurance card and a short letter.

Instead of a response I received a second notice (this time with finance charges) a week ago.

I called the office and the lady I spoke with said "Your Insurance won't cover you because it didn't start until May of 2007."

I said, "May comes before October", and she replied, "Yeah it does, that's weird.  We'll run this through"

A few days later I receive a call from the doctor's office telling me that my insurance won't cover it because they only accept claims within 90 days of the visit.  My doctor's office wants me to pay the full amount.  It's a rather small amount, but shouldn't my doctor's office be responsible to cut their losses it if they neglected to send me a bill until 9 months later?  If they had sent me the bill within 30, or even 60 days of the visit, we could have easily straightened it out before the 90 day window.  Is there some sort of law or general accepted practice to send a bill within a certain time-frame for health related services?

Should I fight it?  Or should I just pay it.

What advice do you have for him?

Comments

[Liz]

I had this same thing happen to me. The doctor's office billed under the wrong insurance so it wasn't "valid" when they finally billed the correct insurance, which I had already given to them. It was their screw-up so I told them they should have to pay for it. They finally agreed and did so. My advice is to do the same. It's not the money, but they should admit their mistake and take responsibility.

[Mr. ToughMoneyLove]

As a professional services provider myself, my answer is that if the reader received the services, he should pay for them. That's how the Dr. makes a living. Insurance billing by the Doctor is a courtesy, not a legal obligation. Not requiring payment in advance is also a courtesy by the Dr. Do not take advantage of that courtesy by saying that you took to long to bill me.

[Gretchen]

A very similar thing happened to me a while back. Call your insurance company. Usually, under the provider's contract with the insurance company, the provider cannot bill you for their screw up. What was the provider doing, waiting almost a year before pursuing it. Also, with HMOs, the doctor isn't extending you a courtesy, Mr. ToughMoneyLove, he or she in complying with the insurance contract, which brings them more patients. Call your insurer, ask them how to deal with the provider.

[Lolita]

True, the billing is technically a courtesy, however, if the insurance card is presented at the time of the visit, as is usually required, then it is understood that the Dr's office is going to submit a claim to the insurance company. If that is the case, then the patient would expect that the insurance is going to cover the cost that is covered under the policy. The patient with insurance does not expect to pay full price for a doctor visit when they are paying for insurance to assist with these costs.

In hindsight, the only thing I would have done differently, if it had been me, is to contact either the doctor's office or insurance company to check the status of the claim. You are required by law to recieve a statement from the insurance company that details what has been submitted by the doctor's office and what the costs incurred were so that you are aware of all charges.

For now, I would also do my best to insist that the doctor's office made a mistake and should cut its losses since they did not submit the claim as they should have.

[Sed]

Moral of the story: give your new insurance info to your Doc as soon as you get it.

[Marilin]

I work for a hospital, when this happens it's considered the fault of the hospital and becomes a timely write off. I would fight it as hard as you can, it's the doctor's office's fault it wasn't billed in a timely manner. 90 days is a standard insurance time limit.

Alternatively, the dr's office should have submitted the bill shortly after your visit. If they DID and the insurance denied it because they got your dates of coverage wrong, it's the insurance's fault and it is STILL billable, since the initial bill was sent before the 90days, but denied due to the INS's error.

Hope that helps, DO NOT PAY the full amount. Take it to small claims court if you have to. Billing errors are NEVER the patient's fault unless you gave fraudulent or incorrect ins and refused to give corrected info (not the case).

[Jen]

It's your responsibility to give your doctor's office your current insurance info at the time of the visit. They spent that 9 months trying to bill your previous insurance company. It's your responsibility to pay for the visit now. If you don't, your doctor's office may forgive the debt, or they may send you to collections. I'd just pay it, and consider it a lesson learned.

[JimL]

The billing becomes more than just a courtesy when they have led the patient to believe that they would be handling this. Yes, it is ultimately your responsibility to pay, but that doesn't mean that the doctor's office is not at fault.

It is very doubtful that the Doctor even knows about your billing issue. Are you willing to consider another option? Perhaps you should let them know that you want to speak directly to the physician about this problem and that you are considering going to another physician. After all, if they botched this collection this time, who is to say they don't do it again. Next time, you could be on the hook for bigger $$$$. In this economy, everyone is concerned about keeping the current customers happy.

[Kimberly]

I might give your insurance company a call and if they still can't help you, call the doctor's office, thank them for doing their best with the insurance company, apologize for your part in any miscommunication (you didn't say whether you had updated your insurance with the doctor at the time of your visit, only that you did after you got the bill) and politely ask if they'll drop the finance charges if you pay right now.

[Jim]

Personally I'd look into it a little further to see exactly what happened in the first 9 months. Maybe the Dr. office billed your old insurance and the old insurance company sat on it for 9 months. Maybe your Dr. office sat on it for 7 months then finally billed your old insurance. Maybe they've been sending you bills to an incorrect address. There has to be a bit more to the story to explain why it took so long for you to find out what went on.

What state are you in? Laws on this kind of topic will vary from state to state. It is possible that your state could have a law requiring timely billing that could apply here. But I bet many states won't have a specific requirement. The insurer and doctor might have a contract on coverage that requires the doctor to bill for coverage within the time period, so I'd ask the insurer about that. Generally an insurer isn't going to accept late bills from a doctor if the insurer has a time limit.

Jim

[Otis]

Doctors do this all the time. While technically you owe the money, realistically it is their fault for not filing the paperwork on-time. If you protest it they will simply drop it (heck, if you don't pay it they will probably drop it), they know it's their fault...they are just hoping that you will pay them because chances are that they will see more money from you than they ever would from an insurance provider.

[Santos]

In good faith you provided the insurance card and had a reasonable expectation that the transaction was over. Jen advices that you pay it and consider it a lesson learned. I say the doctor should write it off, take the tax deduction, and clean up their administrative processes.

[whatever you choose to call me sir]

while the dr may not be able to file a claim on your behalf you may still be able to file a paper claim yourself within a year. Pay the bill and submit it yourself. Bottom line, pay the bill OR submit insurance yourself from here on out. Can't have it both ways.

[Sarah]

You provided insurance information. Even if it was outdated, you could easily have corrected the mistake if they had notified you in any reasonable time frame that the former insurance company had denied the claim because you were no longer covered by them. It's the doctor's fault. If you politely refuse to pay, they will probably eat it.

People, it's not like she sat around waiting nine months for the bill to show up before submitting it to insurance. She thought she had covered it. Yes, she may have made an administrative mistake, but why should she forfeit all insurance coverage because she forgot to update some information with her doctor? There's expecting responsibility, and then there's expecting perfection--from one person, and no competence at all from the other party in the transaction.

[Kevin]

As others have suggested, try working directly with your insurance to get this paid. If you still can't get insurance to cover this, try asking the doctor's office if they will settle for a smaller amount since it was their fault for waiting so long to get this paid.

[ammbd]

What about this:
a hospital brings in a consult or adds a doctor to the patient's team without 1st checking to see if that doctor's on the patient's insurance? Compounds their error by not submitting his bill for services along with everything else, resulting in the patient's family finding out about this by collections notice? When the family disputes the bill via the insurance, the insurance adds to the mess by 1st issuing a retroactive authorization (see, this year the doc in question's on the insurance; last year he wasn't) that they then revoke a few months later putting the family back into collections?

[Benjamin Bryan]

Thanks for all your advice.

I didn't realize it was a courtesy for the Doctor to file the claim. I've never even been asked, they just do it.

I had already given them my current insurance information, it should have been on file.

So with all your advice my plan is to write another letter to the medical group (certified mail this time), if that fails contact my insurance provider directly, and if that fails I'll have to just pay it because I'm in the market for a house, don't have time to deal with it, and can't afford anything negative on my credit. If I do have to pay it I'll switch to another doctor's office... hopefully one that has a competent AR department (or one that at least owns up to their mistakes).

I appreciate all of your advice. Thank you all.

[Robin]

I work in a medical practice and I can tell you that insurances are a major pain to deal with. We submit claims the same week a patient comes in but we know that for the most part it will be weeks before we see a check - if then. A lot of the time the claims come back because we forgot to dot the i or cross the t and when that happens we have to start the entire process all over and wait to see if we'll eventually get paid. Over the years we've been told that a lot of insurers purposefully deny the first claim hoping that the Dr.'s office will just give up! It's exceedingly frustrating to deal with them and sometimes it does take months of going back and forth with them to get paid. Calculate all the money your Dr. spends just trying to collect payment and you will maybe someday understand and appreciate all that your Dr.'s office does on your behalf. I don't pretend to know your whole story and maybe they did mess up but...maybe they didn't. Normally Dr.'s will go to great lengths to not bill the patient directly but they shouldn't have to wait so long to get paid either. Would you be willing to go through so much just to get paid?

[Tim]

I had a simial situation. After some pushing on my part, there is a form that the hospital can fill out that states they HAD filed the claim in a timly manner, and that it is not your fault. This cleared it up for me. IT was my insurance company that told me about the form and to mention it to the hospital.

On the other hand I am currently pay for a doctors visit from 2 years ago. The shots weren't covered under my old insurance for my new daughter. We switched insurance companies during that time. They threaatened to take me to small claims court to pay for it because it was so far over due. I went in showed them all my statements where I was never billed for the service. This helped. In the end I agreed to split the cost 50/50 since I DID have a service performed, but it was their fault for not billing my sooner.

While $92 is not that much, honesty would didctate that you pay bill since you did have a service performed.

[Mary@SimplyForties]

Pay it, pay it, pay it. They can make your life miserable, you can't do the same to them.

[BEVERLY]

A DOCTOR THAT WE HAVE BEEN GOING TO ONCE A YEAR FOR A CHECK UP INFORMS ME THAT I HAVE A BILL FROM 4 YEARS AGO THAT NEEDS TO BE PAID WHY DID THEY NOT TELL ME THIS THE LAST TIME I WAS THERE. IF A PERSON HAS A BILL THEY SHOULD NOT SEE THEM UNTIL THE OLD BALANCE IS PAID IN FULL. DO I HAVE TO PAID THIS OR IS THERE A TIME LIMIT THAT THEY CAN NOT DO ANYTHING ABOUT IT

[FMF]

Beverly --

I'll post your question in a couple weeks. Stay tuned.

[Amanda]

I just received a letter from my former physician's office indicating that my account is past due. I haven't been to this doctor in over a year. I contacted my insurance carrier at the time and they had not received a claim from the doctor for my last visit. They also told me that according to the doctor's contract with them he cannot bill me for charges that should have been filed with them. They will be contacting his office directly.