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  1. #1
    anjikim is offline Junior Member
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    Doctor billed wrong insurance company, now billing me

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

    April 2010: Got new health insurance. Took daughter to doctor. Paid copay.
    January 2012: Doctor sent us a bill saying they billed old insurance company and they were originally paid, but then the insurance company discovered the mistake and forced the doctor's office to repay. The doctor's office now wants me to pay them back because they can no longer bill the new insurance company for something so old. I told them that I provided the new insurance information, but they don't care. I also said it's pretty ridiculous to tell me this 21 months after the fact and expect me to pay.

    Questions:
    1) Am I legally bound to pay this amount? If not,
    2) Do I need to, and how, can I prove that I provided the new insurance information to the doctor's office?
    3) How do I fight this?
  2. #2
    justalayman is offline Senior Member
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    is the new insurance company a managed health care system such as a PPO or HMO?

    and if so, is the doctor listed as a provider under that system?
  3. #3
    FlyingRon is offline Senior Member
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    If the doctor's office isn't helpful submitting to the right provider, call you insurance and submit the claim yourself.
  4. #4
    ajkroy is offline Member
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    Most insurances have a timely filing limit -- and 21 months would be far longer than many companies accept.

    OP, did you check the status of your claim with the new insurance company?
  5. #5
    ecmst12 is offline Senior Member
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    If they are contracted with your (correct) insurance company, they MUST submit the claim to them. If it is denied for being outside the timely filing limit, they can NOT bill you for the visit. It is their fault they did not get paid and they will have to write it off.
  6. #6
    anjikim is offline Junior Member
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    Yes it's a PPO.
    Yes they are listed as a provider.
    The doctor's office already told me it's way past the time limit to file.
    Is there a law I can refer to when writing to them to dispute this? They've sent me to collections.
  7. #7
    ecmst12 is offline Senior Member
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    Contact your insurance company. They can get in touch with the doctor and counsel them.
  8. #8
    JustAUserName is offline Junior Member
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    You're likely too late to easily fix your situation

    I have billed insurance companies for years and seen many people go to collections in your exact situation. It's probably your own fault.

    Knowingly or not you probably signed an agreement with the provider acknowledging that insurance is billed as a courtesy only. You as the patient take the responsibility of providing up to date and accurate insurance information.

    Also if you are already in collections then more than likely 2-3 letters have gone out to your home and a few phone calls have been placed that you ignored. Collections is a last resort for doctors. Hospitals may shoot patients to collections asap because they can afford it but doctors hate the 30%+ that the collections agency takes for getting your money. If you are talking about a large sum of money then the agency will sue you, you can count on that.

    All of the doctor's in house collections attempts will be documented. They will also have at least one representative testifying that you didn't update your insurance and were unhelpful in resolving the issue. They will also provide the forms you filled out with the wrong insurance.

    Next time call the office when you receive the 1st bill. Sometimes they will give you an opportunity to appeal directly with your insurance. Worst case scenario, the office will settle the bill for the same % their collections agency gives.

    Now, if you're ACTUALLY a victim of poor office management and you provided updated insurance timely and never received a single bill or phone call until collections then I would advise you to pay the agency in full anyway. That way you can legally pursue reimbursement at your leisure. Don't ruin your credit for months or years by standing on principle.

    If you actually do end up in court you will have to prove you gave them correct insurance information. A good place to start would be getting complete copies of your medical/financial records from your doctor's office. Look for anything that validates your story that correct information was given timely. Also request copies of the UB/HICF bills for both insurance companies. Get CURRENT EOBs from both insurance companies. Be prepared to give testimony with dates and times that you spoke with people at the office. Find out if they sent you to collections for usual and customary rates (ridiculous) or their contract rates (fair). You might still be able to settle with the agency but please don't believe silly wives tales about getting out of debt, like writing "paid in full" on a $1 check and hoping they cash it. That is useless. They will simply refund the money and the judge will NOT be happy with you for trying to cheat your way out of the bill.

    On a side note, if the insurance company took money back nearly 2 years later THAT may be the illegal part. Check out this PDF regarding insurance refund time limitations by state.
    [url]http://www.medclaimsint.com/Documents/Insurance%20Recoupment.pdf[/url]
    That is really between your provider and insurance company though. It's a very good defense for the provider. I have beaten several recoup. attempts by appealing with that information.
    Last edited by JustAUserName; 04-10-2012 at 02:45 PM. Reason: Decided to add more on what to do if it's not your fault
  9. #9
    ecmst12 is offline Senior Member
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    This is not OP's fault. Did you even read the first post? OP's old insurance PAID the bill, then took the payment back after an audit. The doctor needs to bill the correct insurance company. If it's denied for timely filing, they must write it off.
    Last edited by ecmst12; 04-10-2012 at 04:01 PM.
  10. #10
    justalayman is offline Senior Member
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    Quote Originally Posted by anjikim View Post
    Yes it's a PPO.
    Yes they are listed as a provider.
    The doctor's office already told me it's way past the time limit to file.
    Is there a law I can refer to when writing to them to dispute this? They've sent me to collections.
    it isn't a law you are concerned about. It is the contract between the provider and the insurance company. Due to that, the doctor has likely lost the right to demand payment so, what you do is get on the phone with your insurance company and tell them a provider is billing you for something they (the insurance company) denied. The insurance company should take care of the issue but keep on top of it to be sure.

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