So, I get a letter in the mail today from my insurance company telling me that they've denied a claim for treatment my daughter received. The thing is, the treatment was performed over a year ago (6/17/2007). The doctor didn't bother to submit a bill to the insurance company until a couple of weeks ago. The insurance company denied it because it wasn't submitted in a timely manner (otherwise, it would've been covered at 100%). It's only $68, but still. my employers pay thousands of dollars to provide insurance for me. What's the point if And this doctor wasn't the only one. The hospital where my daughter was born has still not submitted a bill for payment for my daughter's birth. The insurance company isn't likely to pay it now if the hospital gets around to submitting a bill. So either the hospital is eventually going to come after me for the balance (which, I believe, is about $4,000) or they're just going to eat it. We had another one that send us a bill, and I noticed they hadn't subtracted anything for the part that the insurance company pays. I check with the insurance company and that hospital hasn't submitted any request for payment with the insurance company. So I call the hospital, and they tell me they'll handle it so disregard the bill. A month later, I get another bill - same deal - nothing submitted to insurance company, hospital wants me to pay the whole thing. After dealing with that for nearly a year (always calling and always being told that it was being taken care of so disregard the bill), my wife checks her credit and sees that this particular hospital has reported the unpaid bill to the credit bureaus. About a week later, they send us a bill with a settlement amount on it (which was roughly 10% of the total bill). So instead of collecting the $1,200 they would've gotten had they submitted the bill to the insurance company, they took $135 instead (they removed the info from my wife's credit, too). Maybe I'm stupid, but if I could collect $4,000 or $1,200 or even $68 for the low, low cost of a piece of paper, an envelope and a stamp, I'd probably go ahead and just do it (and I can't possibly be the only one who these hospitals and doctors have failed to bill).
What do you expect if we don't even have universal health care in America? Healthcare system sometimes sucks.
Even with Universal Healthcare, the doctor and/or hospital is going to have to submit the record of their services to someone in order to get paid. And it's likely that even under Universal Healthcare, patients will still be responsible for services that the Universal Healthcare provider doesn't cover. So, I imagine that even under Universal Healthcare, this same situation will be entirely possible.
Man lemme tell ya something. Sometimes I think a lot of doctors as being crooks. Not all but there are a lot out there. I know these cats have paid there dues in becoming who they are but sometimes they go too far. Why? Well first of all when doctors can tell you something over the phone they want you to come in and make a copayment of whatever 10 to 20 bucks each time. That **** is ridiculous. Second some of them dont know what they are talking about and prescribe false remedies. I had this wart on the bottom of my foot and I went to 2 or 3 different doctors to take care of the thing but they kept on either burning it off. The other treatment was freezing the thing so it would eventually die but told me it would take 6 months and like 6 treatments. They were also charging my insurance on average of 120 dollars per visit not to mention the copay I had to pay. Each visit didnt last longer than 10 minutes and also I had the bull**** of waiting 30 minutes in the wait room. I finally went to a podiatrist and he just told me to wrap the sucker up with duck tape every day for a month and wala it was totally gone with no scar! Third I hate it when you make an appointment with some doctor and you show up on time but end up having to wait 2 hours before he gets to you. Thats just being greedy. Some of these doctors try to get as many patients as possible in for the day and make them wait only to take a look at them for 10 - 15 minutes and charge you co pay and your insurance company like a bizillion bucks.
I think the doctors/hospitals have a timely manner in which they have to submit the bills. If they didn't file the HCFA within the particular time frame you should NOT be responsible for the balance.
We had a similar thing with a hospital bill from Hawaii. (broken toe -- approx $700 for a bandaid and asprin!). Was even more complex as it was an 'out of country' bill, covered partly by the Canadian med system, and partly by two separate insurance companies. The bill went around and around for about three years -- with no-one wanting to pay 'first.' We knew we were not out of pocket, so we just copied the whatever paperwork we got and sent it to all the contact people we knew with a note to take care of it. Eventually the correspondence stopped -- so I guess they sorted it out. But what a waste of time for everyone. I can't believe you'd be responsible for the bill if the reason the claim was denied was the timeliness of the billing from the hospital. Especially if they were to bill the insurance co directly.
I'll have to look into whatever law there might be. I hadn't thought about that. But there is a difference between the law and being able to convince someone wanting to collect money from you to comply with the law.
this is true. most medical facilities (doctors, hospitals, labs) have a duty to file within a timely manner (90-180 days). if they do not, then most cannot come after you for the money because a clause insurance companies put in their contract with the facilities (I know because lazy medical billers often cost doctors a huge percentage of what they should be making). this is actually to protect their members. the only exception is when you go to a doctor "out of network". often they don't have those claues. the best suggestion is to call your insurance member services and ask if you are liable for the rejected charges and if they say no then ask for a EOB (explanation of benefits) to show to the facility. if they still try and go after you then you can have your insurance member services talk directly to the facility....
I am going to jump on the rant! So I got into UC Hastings College of the Law and I need a physical examination and a TB test before school starts, and I currently don't have insurance since my undergraduate covered me. However, since i graduated, I no longer have that and since I am going to start law school in August, and they also provide me with health insurance, I thought it wasn't really necessary to obtain insurance. So I start calling around to see how much it is going to cost me for a TB and a physical, and I keep getting quotes of $750-900!!!! What the hell is that all about?! I am now my TB is going to be negative since I took one like three years ago for my undergrad so its not like they need to treat me for anything! Also, for the physical, all the doctor has to do is fill out the school paperwork which requires him to check "normal" or "abnormal" for check category! WTF!!!! End of my rant!
