is there a statute of limitations for med bills

[lennstrom14]

What is the name of your state? ny
today i received a explanation of benefits from my medical insurance carrier showing that a claim for physical therapy for services from year 2000 was submitted to them and they denied payment for sending in claim after the time limit..it is 7 yrs later ...it said patient responsibility 0 ..that health center that sent bill can not bill me any $0 ...i am on social security disability ...this was initially medical claim under my car insurance (no fault ) for neck and back injuries my lawyer sent me to for a 2nd opinion that injuries were permanent to collect soc sec disability .. i have not worked since 1998 since accident ..i have medical insurance thru my job since i was disabled and also my husbands insurance co and medicare all have said time to submit claim is over the time limit and that i dont owe this physical therapy anything ...can they try to bill me for services even though they were lax at submitting claims to get reimbursed thru auto insurance and medical insurance ---isnt there a statute of limitations how long they have to bill and try to get reimbursement from insurance co or patient ...thanks for your help ...if they do ask for payment in the future do i reply my insurance said i have no liability it was over the time limit ...thanks again .....What is the name of your state? new york

[averad]

1) When you called your Insurance carrier what did they tell you?

2) Is this provider a contracted provider with your Insurance carrier?

Most provider contracts include a timely filing provision and you will need to contact your Insurance carrier to find out more.

[lealea1005]

You know, cases like yours are the reason some providers either shy away from treating MVA injuries, or require payment up front, and let the patient deal with getting reimbursed from their auto insurance company.

Do you know when the PT office found out they would not be paid by your auto insurance company? How can you assume they wer "lax"? Sometimes it can take years, especially if there are legal proceedings or disability determination involved.

Who is to say they did not immediately file with your health insurance company as soon as they were notified of non-payment from your auto insurance? In my state we MUST wait for a determination by the auto insurance company, and expiration of the patient's PIP (personal injury protection) before we can submit the claim to the health insurance company for reimbursement. In a case like yours, the PT's are stuck not getting paid because of the timely filing period requirements from health insurance companies they're contracted with. The same health insurance company would have intitially denied the claim stating it must be submitted to the auto insurance company first, it's a Catch 22.

When you registered with their office in 2000, did you sign a form stating you were ultimately responsibile for payment if your insurance company denied the claim? I'll bet you dollars to donuts you probably did.

It's a frustrating situation all around.

[ecmst12]

Lea - If they filed with the health insurance immediately after getting the denial from the auto, and they submitted to the auto in a timely manner, then they can appeal to the health insurance company with that info and it may be reconsidered. But that is neither here nor there. Besides, this bill is SEVEN YEARS OLD. I would find it very hard to believe that it took the auto carrier seven years to send them notice of denial.

OP - You are probably worrying needlessly. Your explanation of benefits says patient responsibility 0. It wouldn't say that unless the provider was contracted, so no, they are not supposed to bill you. That's not to say they might not try, sometimes they do, but if you get a bill, you can send in a copy of your explanation of benefits showing $0 patient responsibility and that should take care of it. If it did not, then you could contact your insurance company and they would contact the doctor's office for you. But none of that has happened and most likely will not. MOST contracted providers follow the rules of their contract, why waste money billing someone that they're not legally allowed to collect from?

[lealea1005]

[quote=ecmst12;1604388]Lea - If they filed with the health insurance immediately after getting the denial from the auto, and they submitted to the auto in a timely manner, then they can appeal to the health insurance company with that info and it may be reconsidered. But that is neither here nor there. Besides, this bill is SEVEN YEARS OLD. I would find it very hard to believe that it took the auto carrier seven years to send them notice of denial.

OP - You are probably worrying needlessly. Your explanation of benefits says patient responsibility 0. It wouldn't say that unless the provider was contracted, so no, they are not supposed to bill you. That's not to say they might not try, sometimes they do, but if you get a bill, you can send in a copy of your explanation of benefits showing $0 patient responsibility and that should take care of it. If it did not, then you could contact your insurance company and they would contact the doctor's office for you. But none of that has happened and most likely will not. MOST contracted providers follow the rules of their contract, why waste money billing someone that they're not legally allowed to collect from?[/QUOTE]


Very true, Ecmst12.

Just trying to point out to OP (albeit in my pre-caffeine morning rant ) that the issue is frustrating for all involved. One should not automatically assume the provider was "lax" or purposely being dishonest in trying to collect for a service they provided.

OP should follow your advice to send the provider, or billing entity, a copy of the EOB stating h/she is not responsible for the fee.

Have a good one!