Doctor billed me instead of husband's insurance for daughter's care--2 years later

[Swiggs]

What is the name of your state (only U.S. law)? Florida

I just received a bill out of the blue for a procedure that occurred almost two-years ago--from the on-call pediatrician that happened to discharged my daughter from the hospital after her birth. The bill is addressed to me, though my daughter is clearly identified as the patient. When my daughter was born, we made sure that all insurance matters for her went through my husband's provider--knowing full well I would be leaving my job, and thus my insurance, after her birth. I've called the hospital to confirm this, and their files all show that her insurance was that of my husband's. Yet here I am being billed two-years later.

Can this be fought on the grounds of a clerical error? Obviously my insurance (who they tried to bill) would have no response, given I never added my daughter to the policy. We also never signed any documents with this particular pediatrician, seeing as they were simply the on-call doctor that the hospital provided. All of our paperwork and insurance information was submitted to the hospital prior to birth, thus the hospital would have been the ones who would have provided this doctor with any information (note: all other bills we processed properly, just this one went wrong).

What can I do?

 

[cbg]

Was your daughter properly added to your husband's insurance? Have you confirmed that?

That's your first step. Do that, then come back with the answer and I'll tell you where to go next.

 

[Swiggs]

Was your daughter properly added to your husband's insurance? Have you confirmed that?

That's your first step. Do that, then come back with the answer and I'll tell you where to go next.

Yes. First thing I did was call the hospital to confirm that my daughter was on my husband's insurance--which they did confirm.

Then called the ped's office, they confirmed they had been given MY insurance information from the hospital, not my husband's. Also claim, there's nothing they can do about it now.

 

[cbg]

No, I'm not talking about calling the hospital to see if they show what insurance they have in their records.

I'm talking about calling your husband's employer to confirm that she was actually added to the insurance.

 

[Swiggs]

In that case, yes as well. Insurance company confirms she was officially added on her date of birth.

 

[Isis1]

In that case, yes as well. Insurance company confirms she was officially added on her date of birth.

the problem i see is the fact that two years went by. i do know with some insurance companies, after a certain time frame they no longer accept claims. mine was 6 months. after that, i was on the hook for the full costs of any residual monies owed.

 

[ajkroy]

Timely filing limits may apply, as well. Hospitals know to find out about insurance for both parents (if there are two) so that if one doesn't pay...maybe the other one was supposed to. If the patient was properly added and the information was correctly supplied, it is possible that the hospital may have to eat it on this one.

OP, read your husband's insurance contract.

 

[cbg]

Then the next step is to call your husband's insurance company and find out whether or not the claims were ever submitted and if so, what was the disposition.

We're going to take this step by step cuz otherwise it will get too complicated. When you've talked to the insurance company, let me know if the claims were submitted and if so, if they were paid. If not, find out whether they will still accept them after two years.

That's enough for now. Let me know when you have that much and we'll go from there.

 

[Swiggs]

Then the next step is to call your husband's insurance company and find out whether or not the claims were ever submitted and if so, what was the disposition.

We're going to take this step by step cuz otherwise it will get too complicated. When you've talked to the insurance company, let me know if the claims were submitted and if so, if they were paid. If not, find out whether they will still accept them after two years.

That's enough for now. Let me know when you have that much and we'll go from there.

Sorry for late reply. I appreciate the help.

Talked to insurance; they claim a year is usually their limit on filing claims. They mentioned that I may be able to get the dr. to resubmit the claim under the correct insurance, including an explanation that they attempted to file in a timely manner, just to the wrong insurance. However, the woman on the phone made it seem like this was unlikely to help--just "worth a shot."

 

[cbg]

I wanted you to contact the correct insurance to start with and find out if they were submitted. That was the whole point of the exercise. But it's not too late - do that now.

There are a couple of possibilities, and your legal obligations are different depending on which one is. The bills could have been submitted, but were not paid; they could have been submitted, paid, but the payments never posted; or they could have never been submitted at all. The fact that you are being billed now is NOT evidence that they were never submitted. So now you need to contact your husband's insurance, since that is the one to which they should have been submitted, and find out if they were. If they were, were they paid? If they were not, will they accept them now?

 

[ecmst12]

Generally, if the doctor submits the bills to the correct insurance with proof that they attempted to bill in a timely fashion but did not submit correctly, that will be taken into consideration. More importantly, if they are contracted with the insurance plan and the bill is rejected for being submitted to late, they will be required to write it off.