Bill from a Medical Visit 1 1/2 Years ago....just Got It

It needs to be paid-this reminds of the story about a woman cleaning out her husband's closet-in an old suit she finds a shoe repair ticket that is several years old. She takes the stub to the repair shop which is still in business. The clerk takes the stub from her and goes into the back room. She hears all this terrible noise and commotion. Soon the guy emerges from the back and hands the stub to her and says, "they'll be ready Tuesday!"

First she should call the doctor's office and ask for Billing. This may very well be a mistake that can be corrected with the one phone call.

I believe it is called "Balance Billing". When an insurer pays a doctor for a provided service, the doctor accepts the insurance company's amount. For example, your child gets a vaccination. The doctor says it's $50. The insurance company says the standard payment for that vaccination is $40. They pay the doctor $40. The doctor is supposed to accept that, but sometimes they bill the patient for the other $10. It can happen at any time. If your friend has insurance, have her check to see if her insurance company paid for that visit in June 2010. And have her check to see if that pediatrician is in her insurance company's network.

If she is being billed for the amount the insurance didn't cover but that the doctor was supposed to accept, she can have her insurance company give her advice. You can look up "balance billing" and get more info, but make sure you do an advanced search on Google and only look for laws and regulations that are recent.

Most likely her visits weren't free, but were covered by insurance as part of the labor/delivery/maternity charges. So this may be the portion of the bill that the insurance did not deem reasonable.

If she went to an out-of-network pediatrician or doesn't have insurance, she probably has to pay that.

There is a time limit on how long after the service the provider can submit the bill to insurance. I don't know what the time limit is for "balance billing" the patient though.

I'm not an insurance person, by the way, or a medical person either, just a mom with a chronically ill child and a lot of paperwork and bills and three hospitals and 5 specialists and a million phone calls to the insurance company. So this is just my opinion, not professional advice by any means whatsoever!

They absolutely have a right to collect on the account. I work in a dental office and sometimes things get overlooked, or something gets missed on billing. She needs to call the office and find out why it wasn't submitted to insurance, but ultimately, it's her responsibility to make sure it gets paid.

J.:

If you are really in Indiana - here's what I found on the statute of limitations...

Statute of Limitations

*

After a certain number of years, the statute of limitations on medical debt will prevent a creditor from receiving a court judgment if the debtor uses the statute of limitations as a defense. The statute of limitations varies in each state, but for medical debt, which is normally considered a contract, the time ranges from three to 15 years.

Read more: Statute of Limitations on Medical Collections | eHow.com http://www.ehow.com/facts_###-###-####_statute-limitation...

Insurance companies will reverse charges they already paid on and then the doctor has no choice but to bill you for it.

I would tell her to call the doctors office to find out what happened but most likely it is not in the hands of the doctor but the insurance company.

More than likely the office staff were going through past accounts and cleaning up in order to close out the year. They probably came across this in an account somewhere and just reprinted it and sent it out.

I would call them and ask why it wasn't filed with the insurance, then tell them to file it with the insurance, if the insurance won't pay it because it's too far out of date or for some other reason then she may have grounds to tell them they have to absorb this bill.

If it is a truly owed bill that was submitted correctly through the insurance and everything was correctly done except her part just didn't get mailed when it was supposed to be mailed then I would say she owed it.

Does she have her insurance statements? We had something similar happen but for the dentist. We get a bill 3 YEARS after the service for $300. I had to go back over all the statements from the insurance and do the calculations- turns out they were right- we owed the money. I did call them up and give them a piece of my mind about their terrible bookkeeping, and then found another dentist. :)

We used to get things like this all the time with my step-daughter because the office was billing multiple insurers. Her mother had state insurance for her other kids but would try to slip SD's bills in there too to avoid the co-pay. The state insurer would audit, rescind the payment, then they would bill my insurance co (through which SD was actually insured), they would reject the bill because it was out of date, so we would get a bill in the mail and I would send it back to the office telling them to go after mom, who signed the document saying she was responsible for payments. Eventually my insurance co would pay the bill or it would get dropped.

So...if there was any change in her insurance coverage or something got lost or rejected, it could easily crop up a year or two later (we got a batch of bills in 2008 from 2005). She should contact her insurance company to find out whether or not is was ever submitted to them. If it wasn't, it's up to the office to either get the insurance company to waive the billing period limit (which is what my company usually did for these) or the office should eat the bill.

If you were there on the specified date, pay it. Sorry.

The limit on collecting funds is 7 years.. so they're still in that window. Tell them to call the Dr. office and find out why it took a year to get it and see if they even tried to bill insurance.. that sounds like the full price for an office visit so it may be a simple mistake!

I got a bill for $1,200 from the hospital 18 months after my son was born. And I had done a pre-admittance package with all my contact information 3 days before he was born (they require you to actually go there in person to fill out your pre-admit paperwork too!) I had to pay it.
The following year, I got another bill from them! Had to pay that one too!

Tell her to call her insurance company and talk to them about it. Depending on what they say, then call the doctor's office to try to work something out if she owes the entire amount, but cannot pay in full. Like another poster said, the insurance company may deny it based on the fact that it's over a year old. If the doctor office never filed it, then she might have a leg to stand on to not pay it.
Lately, I've been seeing doctor office bills come as long as 6 months after the appointment. It's ridiculous that they take so long given the advancement in technology and billing.

Good luck!

How very odd. I had a similar situation where I received a very aggressive phone message from the billing office at our former pediatrician for a bill of 100.00 from 2 years ago. She stated she'd left me several messages, (not true), and I needed to contact her right away. I'm going to call her back and ask for a paper statement so that I can call my former health insurance company and compare the bills but she and I need to pay it if it is due.

I just want to add for anybody reading this post now ( I am glad your friend got it resolved BEFORE simply paying the bill):

ALWAYS do your homework and keep records for any and all treatment. BE AWARE of procedures and costs.
ALWAYS try and resolve bills by talking to people-if one person doesn't listen, call back and talk to someone else.

I got double billed for a procedure and was unaware of it until I got the ridiculous bill. I talked to the actual speech therapist about it and she admitted to HER clerical mistake and fixed it.

Also, I got billed in full for hospital services performed under insurance, only to have them state that insurance wasn't paying. Ummmm, no. I called immediately and had to jump through hoops to get the truth out. I only payed 20%, like I was supposed to in the first place.

Always follow up!!

Tell her to call the insurance company right away. She should fax it to them and have THEM call the doctor's office.

I hope it's not too late to get this dealt with. If they won't pay for it, she should go back to her calendar and see if she really took her child to the doctor.

Dawn

I know this is already resolved but I just had to add something funny; well, sort of. After my Mom passed away, we continued getting bills for various things; I either paid them or got them straightened out with the insurance company. So, after many months had gone by, my sister happened to be with me when another bill came in and she says to me: "don't those just go away after someone dies?" Umm, NO!!! She's a little ditzy but I love her!! Just wanted to share!!