The doctor didn't charge the health insurance in time, am I liable?

I got a bill for an emergency room visit for one of my kids. It was the weekend and that was where the insurance told us to go. Luckily no stitches needed. Fast forward 7 months and I get a bill for over $700. On the bill it says that they charged the health insurance company but they did so only last month, over 6 months after the incident. The decline says "time limit expired". The bill would have been covered in full, less the already paid copay, had it been filed on time. So am I liable for paying this bill since the Doctor's office messed up by not charging in time?

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Just saw this: online.wsj.com/article/… - "How to Fight a Bogus Bill" (Many Medical Bills Contain Errors That Could End Up Wrecking Your Credit Score. Here's What You Need to Know)

If they're in-network (and it sounds like they are) you probably don't owe them anything. Network agreements usually preclude this sort of thing.

8 Answers 8

This has a straightforward answer. It's likely that your doctor and the hospital have no responsibility to ensure that your insurance claim is filed in a timely manner. They bill you whether you or they get reimbursed by insurance, or not. The insurance company is more than happy not to pay you any way they can. Sorry if this is harsh, but it's up to you to follow through.

Thanks. The forum post was helpful and almost exactly the situation that I'm in. I've been in touch with the Dr. office and they are looking into why it wasn't filed on time.

For me specifically, I can confirm that there is language in the forms I fill out for my doctor that states that they bear no responsibility for billing, although they bill as a convenience to me. It might be useful to review what you may have signed when you were established with this practice.

If its an in-network doctor or hospital, they have a contract with the insurance company (hince in-network). Part of the contract is that they will bill in a timely manner.

This answer is flatout wrong if the provider is in-network with the insurance. The contracts do give time limits and do say providers cannot bill due to a providers failure to bill. And often even if they DO bill, they are typically prohibited from balance billing to recoup the difference between that they'd like to charge and the charge they agreed to with the insurance company.

I'm not a lawyer but this answer is a joke. The consumer CANNOT know the Mickey Mouse figures of a medical bill before receiving one. Nor would they have grounds to submit "their own estimated bill" to an insurance company. If the insurance company has a "weasel" contract where actions completely up to the Hospital affect whether the insurance works (such as submitting a bill on time) - that's a scam. No consumer should pay it, on principle. Send a message. Bill me in a timely fashion (within 6 months - christ what other industry is even close to that?) .. or don't get paid. Send a message.

I work for a health billing company. It is completely the provider's responsibility to bill your health insurance in a timely manner if they have your health insurance information on file (it sounds like they did). If you can gather a copy of your EOB (Explanation of Benefits) from your health insurance, it will likely say something to the extent of: "claim was submitted after the timely filing limit, therefore no payment was made. The patient is not liable for the remaining balance." Don't let the hospital/physician bully you into paying for something they should have submitted to the insurance in the first place.

Does this hold true for "out-of-network" claims? What is the legal basis for this? Can you cite a reference?

Same as per my experience. Bad auth# for diagnosis. Facility had to write-off charge. In-network providers have contract with insurers. They break it, they take the hit.

I was in a similar situation years back and I refused to pay the bill. My point of view was that I provided the hospital with all information needed to submit the claim in a timely matter and that I should not be held responsible for their failure to do so. In the end they waived the charges. So while technically I might have been responsible for paying the charges, in reality I think they decided it wasn't worth the hassle of making me (I would have fought it all the way up to the top). Not sure that I would recommend this approach though :)

When you say in the end, did you have to fight them? They could have submitted you to collections pretty easily.

@MrChrister To a degree, I just stayed friendly but kept repeating I disputed the charge. I did go up a few levels in the billing department. Of course it helped I always paid all other bills. It's a long time ago, I think it did make it to a collections agency, but I told them I was still disputing the charge and they said they'd take that back to the hospital (which by then had decided to write it off). I didn't hear from them again.

The hospital likely has a contract with your insurance company which makes them obligated to bill the insurance before billing you! I had a similar occurrence that was thrown out when my insurance company provided a copy of a contract with the hospital to the judge. So if there is an agreement they must file with the insurance in timely manner.

I had a similar issue take place at a hospital when the repeatedly billed the "wrong me" -- a stale insurance record left behind from when I was a dependent on my parent's insurance a decade earlier. They ended up billing me for anesthesia when I had a major surgery (everything else was billed to the correct insurance.)

The outsourced billing people were pretty unhelpful (not usually the case with hospitals), so I became the squeaky wheel. I sent certified letters, had my priest rattle the cage (it was a Catholic hospital) and eventually talked myself into a meeting with the VP of Finance, who started paying attention when the incompetence of his folks became apparent. Total cost: $0 + my time.

That is your bill because the services were performed for you.

You still can negotiate with the doctor however. Suggest that while you aren't willing to pay the full share, you will pay the negotiated amount he would have actually gotten from the insurance company (or some fraction thereof). Doc did make a mistake, but you are very much liable for it.

Why would you be liable for the doctors mistake (assuming in-network provider with a contract with the insurance company to bill in a timely manner)

You're liable for the cost of care, and they are liable for the financial loss you experienced as a result of their failure to provide a correct itemized bill in time to file a claim. The two cancel.

Here's my thought - call the insurance company back. Ask them to just tell you what the "reasonable and customary" approved payment would be. Offer that exact amount to the hospital, it's what they would have gotten anyway, and you learned a cheap lesson.