Provider billed me 3 years late.

[kutzemup013]

What is the name of your state? Michigan
My wife went to a psychologist 3 years ago and they billed my insurance company for her visits. Apparently they missed sending one in and we just received a bill from them for it. When we contacted our insurance they stated they don't pay claims submitted over 2 years. Are we liable for this bill now?What is the name of your state?

[ecmst12]

If the psychologist is contracted with the insurance company, you shouldn't be liable for the bill, but check with your plan (customer service) to be sure.

[CALIF-LAWPRO10]

Originally Posted by kutzemup013

What is the name of your state? Michigan
My wife went to a psychologist 3 years ago and they billed my insurance company for her visits. Apparently they missed sending one in and we just received a bill from them for it. When we contacted our insurance they stated they don't pay claims submitted over 2 years. Are we liable for this bill now?What is the name of your state?

My response:

It sure would be wonderful if that dullard, ecmst12, knew what the hell it was talking about. You see, what ecmst12 fails to understand is that your shrink was not "contracted with the insurance company." The big clue to that was your statement, "and they billed my insurance company for her visits." A "contracted" provider doesn't "bill," at least, not like other people think of "billing."

What dullard ecmst12 further doesn't understand is that after such a lengthy period of time, the doctor has placed your current financial status in jeopardy. You see, the doctor knew, or should and could have known, from prior "billings" with your insurance company, that timely billing of the insurance was important, and time was of the essence. The doctor failed in his duty, and has caused you a three year old financial burden that you had no reason to expect.

You need to stop the billing attempts, and teach the doctor a lesson concerning his own negligence; i.e., he cannot be allowed to shift his damages for his negligence onto you so many years laters. Therefore, you should "hit" your doctor with your own lawsuit, to stop him, for damages for breach of contract based on doctrine of promissory estoppel, which is an equitable doctrine. At the very least, if the doctor should sue you first, you would counter-sue the doctor on these grounds.

IAAL

[ecmst12]

A contracted provider DOES bill insurance. A primary care provider on a capitated plan would be an exception, but I don't know of any type of insurance that capitates specialists, other then a Kaiser type extremely network restricted plan. Typical HMO/PPO insurance plans pay specialists on a fee-for-service basis, so they would have to bill the insurance if they wanted to get paid. How many years did you spend working in the health care/health insurance field? If it's a contracted provider and billing can be stopped without a lawsuit, that is a much simpler way to go about it.

[kutzemup013]

I apologize, I should have stated that the doctor is in my PPOM network, THEY neglected to send in the billing to my insurance (NGS) in a timely manner, within two years. My wife called them again yesterday after they, the doctor, sent us a second bill, they admitted that it was THEIR mistake. My insurance still assures me we should not be liable as they have paid all the other previously submitted bills. I think the doctor was just hoping to bully us into paying after 3 YEARS. The sad thing was that my wife stopped going after just a few visits when she figured out he was more interested in talking about himself than my families problems. I still don't trust them not to keep billing me. I would think there is something about a time limitation the can recoup the money...what do you think?

[ecmst12]

It's in their contract.

Send the bill to your insurance and let them deny it. Then send the denial back to the doctor. That *should* take care of the matter. If it does not, you can see suggestions for filing a lawsuit above.