Hospital did not submit claim, it is now in collections

[hollowroad]

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

I'm trying to help my sister and brother-in-law to research their options in a messy situation..... My sister had a baby in March 2008. The hospital should have submitted the birth claim under my sister's health insurance - the hospital had a year to submit the claim to her insurance, but never did, and now the bill has gone to collections. My sister and brother-in-law both spent a year talking themselves blue in the face to the hospital's billing department trying to explain that they need to submit the claim within a year, under my sister's health insurance, to absolutely no avail. The week before the claim deadline (in March 2009) they again both called the hospital's billing dept and told them the deadline would be up in the following week, but the hospital still did not submit the claim. They have now been receiving calls from a collection agency on behalf of the hospital, even though it was through the hospital's billing department's negligence that they did not receive payment. My sister and brother-in-law's insurance company is not helping in this situation (which they wouldn't, since of course it's not the insurance company's responsibility to make sure the hospital submitted the claim by deadline). I need to stress that they were diligent in following up with the hospital NUMEROUS times and often, and it was the hospital that did not submit the claim. Is there anything that my sister and brother-in-law can do in this situation?

[Zigner]

Originally Posted by hollowroad

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

I'm trying to help my sister and brother-in-law to research their options in a messy situation..... My sister had a baby in March 2008. The hospital should have submitted the birth claim under my sister's health insurance - the hospital had a year to submit the claim to her insurance, but never did, and now the bill has gone to collections. My sister and brother-in-law both spent a year talking themselves blue in the face to the hospital's billing department trying to explain that they need to submit the claim within a year, under my sister's health insurance, to absolutely no avail. The week before the claim deadline (in March 2009) they again both called the hospital's billing dept and told them the deadline would be up in the following week, but the hospital still did not submit the claim. They have now been receiving calls from a collection agency on behalf of the hospital, even though it was through the hospital's billing department's negligence that they did not receive payment. My sister and brother-in-law's insurance company is not helping in this situation (which they wouldn't, since of course it's not the insurance company's responsibility to make sure the hospital submitted the claim by deadline). I need to stress that they were diligent in following up with the hospital NUMEROUS times and often, and it was the hospital that did not submit the claim. Is there anything that my sister and brother-in-law can do in this situation?

Sis and bro-in-law should have submitted the claim themselves after it became apparent that the hospital wasn't going to do it.
Was the hospital a contracting provider?

[hollowroad]

yes, the hospital is in their network. i think that is the question you asked?

[justalayman]

In a well known insurance providers rules, the provider must submit the claim as contracted. If they fail, they also cannot bill the patient due to the contractual relationship with the insurance company.

I cannot attest that they all have same acting contracts but it is a very common inclusion in the provider/insurer contracts.

So, you need to get back with your insurance company and research if the provider/insurer contract demands this in your situation.

[ecmst12]

If the hospital is contracted with your insurance, then your insurance absolutely should be intervening on your behalf.

But if you have a copy of the bill that was sent to you, send it to your insurance company and let them go from there.