Ok, I had my son almost 18 months ago. Paid all the bills I owe, or so I thought. A few months ago, I got this bill out of the blue from a doctor I had never heard of. Thinking this was a mistake, I called them. They say that this doc assisted in the care of my son in the nursery. On their bill they showed no insurance coverage and didn't even have his name, it just said boy and our last name. I gave them all the insurance info for them to bill, keep in mind that the hospital and my doctor had all this information from the beginning. The insurance tells me that because this office waited so long to file their claim, it will not be covered. Today, I got another bill from this office. Again, it says that there was no insurance coverage. Because of their neglect in filing a prompt claim, they expect me to pay the entire balance! Do I have any kind of legal backing on this? This just seems very very wrong to me. I mean, after all isn't this kind of bill the exact reason that I carry insurance? Please help! I don't have the $425 they want but I don't want it to ruin my credit. I can't afford to get a lawyer either. If I was gonna do that, I would do just as well to pay the $425. Anybody, PLEASE! Thanks in advance for your responses!
OK, I found my statement from the insurance company. The doc that is trying to bill me is "in network". It states plainly on the insurance papers that the amount this doc is allowed to bill me is $0.00. I sent a copy of this to the doc with a note that I was less than happy with their practices and that being in network, they should have known that they had a time limit in which to file. I also stated that this is their mistake not mine and not that of the insurance company. So, we'll see what happens. If I had to, I could pay this but I think one M. really hit it on the head when she said that this is just as much about principle as it is about the money! Thanks mamas for all your help. Your support has been very enlightening and empowering! I am M. hear me ROAR! Thanks again.
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M.R.
answers from
Columbus
on
Hi there.
I think this sounds like a scam. In my experience, you are billed by the hospital for any care recieved in the hospital. I would call the hospital and see if their billing department can help you. I would hate to see you get scammed!
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M.H.
answers from
Cincinnati
on
This is the kind of insurance rip off that Howard Ain goes after. Give him a call or an email.
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B.R.
answers from
Columbus
on
Shannon,
This definitely sounds suspicious. Talk to your insurance company first. You have to write a letter to all three credit agencies disputing any negative info this doctor or his collection agency reports on you and that will stop it from ruining your credit until you get it resolved.
If worse comes to worse, you may have to pay and submit it for reimbursement to your insurance company. Ask them. However, if they won't pay because the dr. submitted too late, then it is their fault and you must dispute it! Good luck.
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L.
answers from
Cleveland
on
I had a fall and dislocated my shoulder. I got a bill about a year and a half after the accident that said I had no insurance at that time. I had the coverage but the hospital did not bill the insurance company. I no longer had the coverage at the time I received the bill, but I had the hospital send me an itemized bill with the correct dates of service, then I sent this to the insurance company(keep copies of course)and they paid the entire bill.
When you sign papers giving permission to treat you, it says in the fine print that you agree to pay anything your insurance won't pay. However, if the insurance was never billed, you can usually submit the bill to your insurance company, explaining that you just received it, and they should pay.
If this doesn't work, I would contact the doctor and arrange "hardship" payments, like tell them you can only afford to pay five dollars a month. That way they will not turn you over to collection, and you can still feed your children.
These doctors cannot even comprehend what real people go through. I've had to figure out a way to pay bills and buy groceries with only half enough money to do so. Families are really under attack nowadays. Best of luck,
L.
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D.W.
answers from
Jacksonville
on
Legally insurance doesn't have to pay if it's longer than 12 months. I used to work in billing for several Physical Therapy clinics and I still work for that same company but at a clinic itself. I would talk to the doctor. As a corteousy if this happened at one of our clinics we would write off the balance besides the co-pays or deductible. Our Physical Therapist, Billing Coordinator, President and CEO of the company are the people who can make that decision. If someone in billing can't do this, talk to the doctor. That seems a bit ridiculous!
On a different note, it's kind of a reminder how important putting back money in an emergency fund is.
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K.H.
answers from
Dayton
on
I had this same thing happen to me when my first and second daughters were born. Because these folks have waited outside the realm of 364 days to bill your insurance -- this is thier fault, not your responsibility. At the time this happened to me, my wonderful uncle was still living who was an attorney and wrote 2 letters that solved the problem promptly. Send them a letter stating that they had 1 year to file claims -- send them comfirmation from your insurance company that no claims were filed and let them know that you are not responsobe for thier faulty billing department.
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D.M.
answers from
Kokomo
on
Shannon,
Your insurance provider will generally send you an EOB (Explanation of Benefits) with each filed claim. It is outlined to show the charges submitted, the allowed amount of benefit and then OOP (Out of Pocket) Deductible then your Co-PAY and last the amount they paid.
Now if there is anything in the Deductible column you may owe this (??) or if there is anything in the OOP Deductible column you may owe this (??). However, there is usually an explanation at the end of the EOB to outline your RESPONSIBILITY.
If the insurance provider has determined that this particular claim was submitted well past their guidlines for REVIEW/PAYMENT you obligation to pay is ZERO, especially if this DR. accepts insurance thru your provider.
Call your insurance provider's fraud department if you think you have been harrassed with the BILLS. They can help you on this one.
I just had the same thing happen to me on a claim that had been turned back for more detailed info from the dr. and he failed to file the info in the required time alotted and was denied payment and I DID NOT have to pay nor will he be able to bill me on the claim. It would appear to me that this office is using strong arm to scare you.
Just get in touch (Call) your insurance carrier/provider.
D., Indiana
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D.G.
answers from
Columbus
on
Shannon,
I don't think you are legally liable for a year and a half bill.Tell them you recieved no other bills from them until now.And if they didn't bill your insurance company it sounds as if some Dr. is just trying to get some extra cash some how.Could this be for having your son circumsized ? I would call the hospital and ask for a detailed bill on your stay.And find out just exactly what this person did for your son.This will include every pain killer you got anything they did for you or your child.
If it isn't on the bill tell them you will give them $3. a month.Yes $3.,they will reject it and you will no longer owe them anything.If they refuse payments you can afford You owe them nothing.I was in this situation years ago.I had no insurance and was self pay,made arrangements with the Dr. to pay him $20. a week until the $3000. for my surgery was paid off.After paying many weekly payments I was told they could no longer except such small payments.I said please put that in writing, the woman did,when the attorneys called I sent them a copy of what she wrote on his office letter head.The attorneys said I didn't owe another red cent. Good Luck.
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A.W.
answers from
Toledo
on
Have you tried to call the Hospital and ask if this Dr even works at/for their Hospital in the nursery or in any department for that matter? If you want to ask a lawyer they will normally answer your question over the phone. Good Luck!
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N.K.
answers from
Cleveland
on
Hi-
I used to work in medical billing and the company I worked for would bill the insurance company and if we got a denial for "timely filing" we would write off the balance if it was our fault that we did not have the correct insurance information but if the patient was negligant and failed to give us the information then the patient would be responsible. I would call the provider first and ask them if the ever billed your insurance company and if they say no they should at least bill them even if they do get a denial if they have a contract with your insurance company they should write off the balance according to their contract. Hope this makes sense, bottom line I would say if they just neglected to ever bill your insurance they are responisble.
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A.S.
answers from
Fort Wayne
on
My husband sells group health insurance, he says that the insurance company has to pay. He recommends reading your insurance policy, there should be a time limit for doctors to file claims. If the they filed within the time limit then insurance is obligated to pay.
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S.D.
answers from
Indianapolis
on
First, I'm assuming you are in or near Indianapolis because it was posted in my daily digest. However, sometimes questions sneak in from other areas (I seem to post to Chicago for no reason once in a while.) If you aren't in Indy, disregard the rest of this message!
This is just the kind of thing they like to investigate. At the very least, this sounds like the doctor's fault and not yours or insurance's. At the other extreme, maybe this is some kind of scam where your name was seen in the paper as having a baby and they waited long enough to know your insurance wouldn't pay and they are trying to get money out of you:( Either way, if they are doing it to you, you probably aren't the only one.
Also, your insurance, whether accepted or denied, will have record of the claim being filed if the doctor really did try to file. So, call your insurance and ask if they have a claim from this "doctor" at all. Also, call the hospital and see if the doctor is listed in your baby's charts. No one can care for your baby without it being logged in, so if the doc isn't on the chart, you know they didn't care for your baby at the time and you can deny payment on that alone.
Don't worry too much, from what I can tell, there's nothing they can do to make you pay, so it's just about getting it straightened out, not about figuring out how to pay. But, I'd contact Call 6 because then they will do the work for you!
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K.S.
answers from
Cleveland
on
Sounds like a scam to me...
Call Better Business and tell them.
What does the Hospital have to say? I would have them get involved....Have they had complaints about this Dr. .
It just is not right!
Hoping all turns out well, and I would just wait to see if it hurts your credit rating. probably not.just relax & wait for a bill from a collection Co. and then respond to them with the facts.
Bless you and yours
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M.L.
answers from
Cleveland
on
When we went to purchase our house we were told that they never care about medical on your report. Its only the other stuff. I wouldn't pay it unless he can prove he was an attending through records and then I probably wouldn't anyway. Some places send bills randomly because they know people will pay.
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D.G.
answers from
Columbus
on
Ignoring the bill will not make it go away. My recommendations would be to, first, contact your insurance company to find out if they received a claim from that particular physician for the specified date of service. If they received it after the "timely filing" limit and it's a contractual agreement, the physician's office must write it off and you are responsible for $0.00! If this is the case, then contact a supervisor of the billing office for this physician and let them know you spoke with your insurance company, this is a timely filing claim, please look into it.
Hope this information is helpful.
Blessings,
D.
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C.S.
answers from
Toledo
on
Dear Shannon,
You should seek advice from a lawyer. The ones where get free advice one the first visit. Why was this doctor assisting in your son's care and you were never told. He should have came to you and introduced himself to you and ask you about your son.
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H.K.
answers from
Indianapolis
on
Have your hubby's benefits person deal with it. That's what they're their for. They know how to deal with the insurance companies. What ever you do, don't pay the bill out of your own money. You'll never see the cash again. Good luck, relax.
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M.M.
answers from
Columbus
on
Some times doctors offices will do that. Its happened to me before. A friend of mine that is familiar with that stuff told me to ignore that bill because for one if it was a ligit doctor bill for you and the baby they would of had your insurance info from the start. and trust me doctors offices dont let that stuff get bye. Anyways if you ignore it they will quite sending the bill. It wont mess with your credit because its at there fault and yes you would have a case against them. Plus like i said they didnt have your info.
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D.K.
answers from
Canton
on
Hello Shannon, my name is D. and I work with insurances at work all the time. If we send something into insurance and they don't pay because it was to late we are not allowed to bill the patient because it was our fault. I would say that u should have a legal action not to pay them. Hope this works out for u. Bye
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D.D.
answers from
Indianapolis
on
If you gave your insurance to the hospital at the time of service, call your insurance company to see if whoever is billing you has a contract with your insurance company. If they do have a contract and you provided your insurance info at the time of service they have to write off the balance per their contract with the insurance company.
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K.R.
answers from
Youngstown
on
What a mess!
I would call the hospital first to make sure the dr's office is legit- you never know about all the crazies out there that are trying to get money, steal identities etc.. If it is a legitimate bill, and you cant get your insurance to pay it, it would cost probably more than the bill to get a lawyer to fight it. However a Dr's office cant turn you into collections (therefore it going on your credit) if you make some kind of payment. Figure out what you can afford- even if its only $10 a month and pay it- they won't like it of course but as long as you are paying them your credit will be ok. And think of it this way they waited 18 months to bill you they can wait another 18 months to get all their money!! Good luck- I hope it works out for you.
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J.S.
answers from
Fort Wayne
on
First, check with the delivery doctor and hospital about this NEW doctor. Be sure that he was doing what he says. Records get messed up all the time. (DM)is noted for this. As long as you pay even a dollar a week, they can not legally do much. But keep checking with your insurance and doctor office. Since they are at fault, even though they don't admit it, they may reduce the fee. The Better Business Bureau and Small claims is a place to check also. Don't give up and stay positive. Been through this often. God Bless.
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M.C.
answers from
Indianapolis
on
I don't know if this will help or not, but I had this same problem with a doctor that I was seeing several years ago for infertility. The bill was for $625, and the doctor waited too long to file (over a year after treatment). So the insurance refused to pay. I complained to the doctor's office, telling them that they had agreed to file my insurance before I paid the balance that was due. Because they didn't do so in a reasonable time, I was not going to pay. The doctor ended up writing it off, and I didn't have to pay.
I don't know if I had a legal basis for refusing to pay or not, but it worked. You might want to ask your insurance company to go to bat for you. Or ask to read over the paperwork you signed concerning your responsiblity to pay when you gave birth to your son. If it reads such that they'll file your insurance in a timely manner, maybe legally you're covered. Otherwise you may have to pay.
If you do have to pay, ask if you can pay it off over time. When I've asked my dentist about paying large bills that I just couldn't afford to pay all in one lump sum, his office was happy to allow me to pay over time. I just had to work out a payment schedule.
Hope this helps.
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C.W.
answers from
Cincinnati
on
You could have a one time consultation for free with a lawyer on most things and this might be one but what about calling your local television station. Here in Cincinnati they just love those kinds of stories. Your problem could just be the icing on the cake as they say. Maybe this has happened to others and most are just paying the bill instead of fussing about it.
A similar thing happened to my husband just recently. He went to the state dr to have some tests done for his disability hearing and sent the bill to his insurance who denied it. Well they sent us a bill and I complained very vocally. I stated we would not be paying this bill because it was ordered by the state not his doctor and they needed to go back to the state for payment. Well what it was they were trying to charge the state twice and the state was who sent us the bill. Needless to say it's taken care of.
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J.R.
answers from
Cincinnati
on
DO NOT PAY THE BILL!!! I had this happen to me a short time ago. I called my insurance company and asked them why they had not covered it and they said that they are no responsible for bills that have been submitted from Dr. Offices after a certain period of time. They also said that I was NOT TO PAY because I did not have to. Ask your insurance company to call them, that is what they are here for. Once my insurance company called the dr. office I called back a few days later and the distibute had been handled, the bill was not paid it was deleted for the Dr. Offices neglience in filing a timely claim.
Call your insurance co. again, I am sure they can assist you.
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K.P.
answers from
Dayton
on
You need to keep fighting this, go up the chain of command within the insurance company, Tell the Doctor's billing office, that there is no way in hell you're going to pay this WHEN in fact, you had insurance at the time of service, and it wasn't your fault that the claim wasn't ran properly. Timewise doesn't matter, if you had the insurance AT THE TIME OF SERVICE, THEY CANNOT DENY THE CLAIM!! You should also "just for fun" tell them you are going to contact the local tv stations/ newspapers and tell them your story. I can assure you they won't want the bad press. You are not responsible SINCE you had insurance at the time of service. Would love to know what comes of this.. Hope this helps!
Kathy
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S.O.
answers from
Toledo
on
Shannon,
I believe there is a code of law stating about billing procedures of doctors and hospitals. I believe if a doctor or hospital sends a first bill after 1 yr of the date of service you are not liable. But, depending on circumstances maybe you should contact the AMA or Attorney General in your state for a clear understanding of the billing procedure.
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C.T.
answers from
Cleveland
on
I have had this happen to me, more than once! My insurance company said that I was not responsible to pay. I had to call the insurance company and have them make a 3 way call to the provider and tell the provider that they are out of luck for waiting so long to bill me. The provider said alright, and I piped in and asked for their name and all information to reference the call. Then I insisted that they send me a letter stating that it is agreed that I am not responsible for the bill. Sometimes it took 2-3 repeat calls, but it got straighted out. Each time I went through the insurance company to make the call. I figured that the bill is going to be taken care of by either one or the other, but not me, so let them fight it out with me as a witness. The insurance company knows the law and backs up their stance not to pay, and knows your rights. Try getting help from them first.
On another note, whenever I sign papers for medical care, I specifically write on the papers as an added statment, that I refuse care from anyone outside of my PPO unless it can be deemed as emergency medical care. That way, if a dr that I don't know about provides some service, I am not responsible for any portion of the bill that otherwise would not be covered by my insurance. This has helped on more than one occasion.
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J.S.
answers from
Columbus
on
I think I would check with your Dept of insurance with your state also. I know in Ohio we have one so I would assume you would have one in Indiana. I would hope they regulate how the insurance companies operate. I know that I have had drs not bill for a couple of years (because of their mistakes) and my insurance company paid. Maybe the state can tell you if they have to pay. Good luck I know insurance companies try to get away with what ever they can.
J.
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T.N.
answers from
Cincinnati
on
First I would call my insurance company, if it is a big insurance company they should know exactly how to handle this. If this is insurance you have through an employer they may have someone who deals with the insurance company. I went around and anround with my insurance over a hearing test after my son was born it was $2000 and my insurance said it wasn't covered I made one call to the lady who handles insurance at my husbands work and she took care of it. If this doesn't work call the doctor who is billing you, be firm but nice, you had insurance and it was their responsibilty to bill them in a timely manner. If nothing else works and you do end up having to pay them make small payments, doctors and hospitals are not aloud to report you to credit agencies if you are making an effort. Growing up my parents never had insurance and my mom paid $20 a month until a large hospital bill was completely paid.
Good luck.
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S.F.
answers from
Fort Wayne
on
Talk to the hospital administrator and indicate the hospital did not file the claim correctly with your insurance provider. If they were having problems filing the claim, they should have contacted you promptly. Because of late billing procedures, the insurance company will no longer accept new claims. Explain that under normal circumstances the insurance company would have paid XX amount of dollars. Negotiate down the cost due. Explain you will pay 25% of the bill or whatever you can afford or deem appropriate. If the insurance was going to pay in full, perhaps the hospital can contant the insurance carrier and negotiate a rate between them.
If you really can't afford any sort of pay-out, they are able to write-off the medical bill. In this case, they really should write-off the amount the insurance carrier would have paid since the lack of payment is due to their negligence.
I would absolutely seek legal advice! We did not recieve a bill from our delivering doctor until 6-8 months after our daughter was born and insurance said THAT was too long. The doctor's office realized their mistake and had to write it off. It is not your fault they waited so long to bill insurance or yourself.
Also, it sounds fishy to me that you would get a bill from a doctor you don't know that "cared for your baby in the nursery". The only doctor that should be caring for your baby (unless their were special circumstances) is your pediatrition.....that's what I've always encountered anyway. You should be able to seek out legal services (which is free legal advice) if you want to pursue this.
You may also just be able to fight it with the billing dept. in the office as well just reminding them that it is not your fault that they waited to bill, if in fact this was a service you recieved. I might also call the hospital and speak to someone on the OB Floor and inquire as to weather or not this is standard procedure for their nursery.
Good luck with all of it!!
J.
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E.E.
answers from
Indianapolis
on
woah. i'd call the hospital. this sounds awefully fishy to me
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E.A.
answers from
Columbus
on
Keep calling and ask for a supervisor at your insurance company if you get the run around. I had $25,000 of claims denied when my baby was born(L&D, NICU, etc), EVERY ONE denied! I fought them, they denied again. Finally I got someone on the phone who helped me. This was after dozens who would not. Keep at it, that is what you are paying them for. Your baby is covered under your insurance at birth. Maybe you should call the Dr's office and suggest that since they cannot file in a timely manner, they can assist you with a resolution, or they can eat the bill :)
They are all jerks for pulling this trick on you!
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M.S.
answers from
Columbus
on
I've worked in the medical billing field for over 17 years and this happens alot! First, does the doctor participate with your insurance company (is he in your insurance network)? If so, what will more than likely happen, is that his office will submit the claim and the insurance company will deny for timely filing limits and on the explanation of benefits it will say that the patient doesn't owe anything.
If the doctor isn't in your network then you are technically responsible for the bill. If that is the case, then I would recommend discussing it with the office's billing manager and explaining the situation. If you had no knowledge that the doctor saw your son and you have been at the same address this entire time with same phone #, then therefore, they really can't expect you to pay something that you didnt' know about. Especially when your insurance company would probably have paid the bill. The other thing you can ask is for the bill to be discounted down to what your insurance company would have paid. No insurance company will pay the full amount billed for a service.
Good luck & feel free to email me if you have any other questions!
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A.C.
answers from
Cleveland
on
No info what so ever!!!!Call the patient care advocate @ the hospital you delivered and ask for their assistance and call you insurance co. I had 6 surgeries in a 5 yr. time and had millions of people claim the treated me...
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J.B.
answers from
Dayton
on
Shannon,
Welcome to the world of Health Insurance. I am not sure if there is anything you can do w/o the help of a lawyer. I will say this...if you do get a lawyer and it is decided in your favor then that party is also responsible for your lawyer fees. A lot of lawyers will do a free consult...I would call some and tell them your situation and just see what they have to say. I would also call the doc who is billing you and tell them the situation and mention you are looking into getting a lawyer bc you know that you are the innocent party. Hopefully they will then just write the bill off bc it would cost them so much more money. They would have to end up paying their own plus your lawyer fees and eating the bill on top of that. They deal with insurance companies eveyday and know it is their responsibility to file their claims within the alotted time frame. This is also going to be a tedious battle for you and very frustrating bc you are the innocent party having to deal with all of it. I spend almost everyday doing this sort of stuff (it does happen a LOT)bc my youngest daughter was born with several health issues and had 5 surgeries by the time she was 9 months old plus LOTS of ongoing care and testing. In the end if you do somehow get stuck with this bill tell the dr. office that you are willing to pay $10 a month until it gets paid for then and use the defense that this bill should have been covered under ins. had they done their job properly. They shouldnt give you any grief at that point and at least the bill will not go onto your credit and its also not breaking your pocketbook. I also want to add a bit of info. A LOT of people out there think that medical bills will NOT go on your credit. I want you to know this is NOT TRUE!!!!! The laws have changed in recent years and trust me form someone who has medicla bills floating out of their ears! DO NOT buy into that...bc I did. I wish you the best of luck in this battle and hopefull you can just be verbally aggressive (but polite) and get them to eat the bill.
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E.G.
answers from
Bloomington
on
1st get a detail and proof that your child was seen by the doc. Second a simmilar situation happened to me. My son was a 3 month premie, a doc didn't bill for services for over a year after his birth. After insurance rejected the claim we sought legal representation (it was for about 10,000) and found there was a time limit for when the doc could bill us and we were not required to pay as we had provided all the necessary info and the time had expired. You may want to look into this...although your bill is considerably smaller than ours was. It is the principle as well as the cost!
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B.C.
answers from
Toledo
on
Have you checked w/the hospital to see if this Dr. really and truly was there and on duty while your baby was there? I keep getting all this SPAM/SCAM type stuff in the mail and email that it makes me wonder. The bill doesn't have much info to go by and again this sounds suspicious to me. Check w/the hosital and the BBB and possibly the Medical Association to see if this is legit.
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T.D.
answers from
Indianapolis
on
Shannon:
File a complaint against the physicians office with the Indiana State Medical Association. Their phone number is listed and they are located at 322 Canal Walk, Indianapolis.
Also, file a formal complaint with the Insurance Commissioners Office. It is far from your fault the physicians office neglected their responsibility to bill the insurance company timely.
Good luck. I have had similar issues and was able to resolve them favorably.
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L.L.
answers from
Columbus
on
Doctors and Hospitals have been know to file false claims. This sounds like a scam to me. Have you requested information showing proof he was there? This sounds very fishy, why would a doctor wait 18mo to bill you. Don't pay it and call the Attorney General and the BBB to see if he's been listed. Ask for his credentials and ask the Hospital if they know this doctor and have every worked with and have record of him treating your son.
Then fight the bill. Tell the doctor this is a bogus bill and you're reporting him to the Attorney General, the Docotors board, ect...
Good luck,
L.
PS let us know how it turns out.
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S.P.
answers from
Indianapolis
on
Pay them $5 or $10 or $1 a month until it is paid.
As long as you are paying something they cannot turn it over to a collection agency.
Keep your bill receipts and checks and make sure they have to send you a bill every month.
That alone will cost them probably as much as you are paying!
It is ridiculous that they were so late in billing you.
That is what I would do.....
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L.G.
answers from
Cleveland
on
Hmmm... it sounds pretty fishy to me. I think it is a scam. I would make every effort to find out if the is a real doctor. Call the hospital and ask for that doctor' office phone number and basically find out if he is for real. If he is, I would contact his billing office via phone to find out why they didn't process the insurance in a timely fashion. If they processed with an old insurance policy you had prior, but not your most recent one, you should be ok because the attempt was in an a timely fashion, and now they just need the updated policy.
Obviously, if the hospital has never heard of this guy before and can;t provide any info, it's probably a scam and you should not pay.
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M.
answers from
Cleveland
on
Hi Shannon!
I work for a collection agency that deals with medical bills that are in bad debt. The doc that is billing you should write this off as this is their fault they never billed you. Just an FYI, doctors and hopitals always bill separately. Also, it is your responsibilty to provide the insurance info at the time of service. But if this is not possible because 1. you never knew this doc saw your son, and 2. they never contacted you in a timely matter to obtain the insurance info to file a claim in a timely manner, then no, this bill is not your responsibility at all. It is stated in your insurance policy what the timely filing limit is for claims. And all providers know what this limit is. Normally, you would have received a bill within the first 30 days after your son was born, since they didn't have any insurance info on you. And then you would receive at least 3 more (once a month) notifying you that your bill is past due and then one stating you are being sent to a collection agency. They would also try to contact you by phone at your home and work. That's pretty customary. Once you're sent to the collection agency, the agency then starts sending you letters and calling you at home and work. If the doc's office had a wrong address or phone/work number for you on file, this would obviously affect they're attempts to contact you regarding this bill. But once it was sent to collections, the agency would run a credit report on you to obtain demographic info on you so they could successfully contact you about the bill. There are so many steps in place to collect money on this bill (which isn't small enough that it would be easily overlooked). I would even dispute the fact that you have never even heard of this doctor. When I had my son, I was notified of everything that happened to him and who saw him while we were in the hospital. You can request medical records from the hospital to get proof that this doc did treat your son. That would undeniably prove that this did or did not happen. Also, review the demographic info on the bill to make sure everything is correct. Call the doc's office to see what phone number they have on file. Either way, 18 months is WAY too long for them to finally be billing you. Insurance filing limits differ from company to company. They range from 4 months to 1 year depending on who your carrier is. The bigger ones are Aetna (4 mos), Medical Mutual (1 year), United Healthcare (6 months) and Anthem (6 months). As far as your insurance company goes, you might be able to talk to someone to see if they would still consider it for payment under your circumstances. But please try to get those medical records before doing anything else. Once you get that, you'll know which steps you have to take next. Good luck!
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K.G.
answers from
Dayton
on
You need to call the doctor who is billing you and tell them they must cover the cost since they waited too long to file the claim. It was in no way under your control so you can't be faulted. I also think the insurance company has to be wrong. They don't pay because of when they get the bill, the pay for when the time of service is. Do not pay!!! You should be able to consult a lawyer for free and I would definitely do this if they continue to charge you. Also sometimes getting a man on the phone can make a difference. Stupid but true.
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B.W.
answers from
Columbus
on
Hi Shannon, if your son was covered the time of the treatment, the insurance should cover no matter when the treatment was. I just had a similar situation, however it had not been so long. It doesnt seem fair. When you talk to you insurance company, I would request to speak to a supervisor or manager to see if you could get any results.
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T.H.
answers from
Terre Haute
on
Hello Shannon,
I would call the hospital you had your son at and ask for a detailed bill. This should list any medicines and any caregivers that where taking care of your son. I have never got a medical bill so late. It just sounds like someone is out for the money only. I would check into it first before giving any information to them. Ask your Ped. Doc. if he/she knows the doctor that cared for your son while in the hospital. Just remember that you can always have a free visit with a lawyer and ask them what should be done. I have done this a few times over medical bills. It helped me make the right decision.
Good luck and if you have to pay the bill pay 10 dollars a month they waited 18 months to bill you and they can waited as long as it takes you to pay the bill off.
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R.K.
answers from
Dayton
on
Check to see if your insurance company has an ombudsman service--they should, and if so, may be able to advocate for you.
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A.B.
answers from
Cleveland
on
Its my understanding that medical bills will show on your credit, but will not affect it like a credit card or loan would. So for example, if you wanted a new line of credit, it would show that you owe the amount, but most companies will not hold it against you (I dont think that any do). The reasoning is that most people cant help that they needed medical services and most dont have the ability to pay. You can also write a "note" on your credit report explaining the situation. Have you talked to the office and explained to them what the insurance company told you? I would not pay the bill either. After I had Maria we had bills with in the next week and a half! Good luck.
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M.N.
answers from
Columbus
on
If legally you can't work anything out between the doctor and your insurance company (the insurance company should pay based on the date the claim happened not based on the date they received the claim - you may want to look into that as well) - call the billing department where the bill was issued and ask if you can make monthly payments - I've done this twice with hospital bills from the actually hospital and they've always been really nice, usually giving me a year to pay it off.
Hope everything works out in your favor. Good Luck and God Bless,
Mel
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L.H.
answers from
Dayton
on
Hi Shannon, I had the same problem when my husband was treated for cancer. This bill is on them since they did not submit it in a timely manner. You are not responsible. Tell them that also. If they send it to a collection agency I'm pretty sure you can take legal action against them. Good luck. L.
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A.C.
answers from
Dayton
on
I don't really know what you can do, but I would start by contacting Ohio's insurance department and talking to them. They have a website: www.ohioinsurance.gov . Maybe they can give you some guidance. It's a terrible situation and I wish you the best of luck.
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T.K.
answers from
Cleveland
on
Hi Shannon!
Your claim was denied by your insurance company due to timely filing. All insurance companies have different time limits. You are not responsible for denials due to timely filings. Even though it was wrong, we ALWAYS billed the patient when we received denials for timely filings at the pysch office I worked. The patient would either pay without any question because they don't know their policy or they would call and question, and when they did that, we would drop the charge.
I would call your insurance company first thing and ask if you are responsible for this charge. Make sure you record the exact number you called, the person you spoke with, the date, and the time. I am 99.9% certain you are not responsible. After you talk to your insurance company and find you're not responsible, call that doctor's office and relay all the info; who you spoke to, when you called, the number, etc.