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  1. #1
    ROSSCO Guest

    Angry Who is responsible for not filing the claim in timely manner?

    What is the name of your state? Kansas

    I had an emergency room visit April 2002. My insurance coverage was denied because the claim was not filed in a timely manner. I had contacted the hospital and my insurance many many times about the claim. The hospital said they had filed many times and had never heard back from the insurance company. The insurance company said many times they never receved the claim. So I would then call the hospital back to tell them to please submit - they would tell me they had. I finally asked for everything I needed to file the claim myself - but by then it was too late - it was over 6 months! My bill was for $900.00 and the insurance would have paid $400.00 after my $500.00 dedeuctible.

    Am I really responsible for the full amount now? Is there something I can do about this? I have wrote the billing supervisor many times that I feel I shouldn't be held responsible for the $400.00 that would have been paid. They never filed but told me that they did. If I would have know that I would have taken care of it a long time ago myself. I have been making payments on this account for the last year. Always writing the balance I feel I owe on the check & statement.
  2. #2
    MellowCat is offline Member
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    Jun 2003
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    I don't know about Kansas, but in Texas, the medical provider submitting the claim is responsible for filing it within the filing deadline and cannot bill the patient for the denial, unless the patient did not provide the provider with correct insurance information in a timely manner.

    I get the feeling they probably *did* file your claim, but it got "lost" somehow. I've done medical billing for 7 years and you wouldn't believe how often claims never make it to the carrier after multiple attempts! The provider should have means of proving timely filing and all they would have to do is send it to the carrier. If they lack this proof, then you are not responsible (at least in Texas) .
  3. #3
    Garp72 Guest
    Mellocat - or anybody! - I am experiencing a similar problem in TX. 2 hospitalizations each in April and May of 2000 were sent to collections. Insurance company saying it will deny claim due to delay in claim. Originally there was a problem with the claim because my primary insurer required an EOB from my secondary insurer and never received it. My secondary insurer was the hospital where I was employed.

    What is the deadline for a timely claim by the hospital and what are my rights if the secondary insurer (who is also my employer) does not submit an EOB at all? Any input you can offer would be awesome!
  4. #4
    MellowCat is offline Member
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    Originally posted by Garp72
    Mellocat - or anybody! - I am experiencing a similar problem in TX. 2 hospitalizations each in April and May of 2000 were sent to collections. Insurance company saying it will deny claim due to delay in claim. Originally there was a problem with the claim because my primary insurer required an EOB from my secondary insurer and never received it. My secondary insurer was the hospital where I was employed.

    What is the deadline for a timely claim by the hospital and what are my rights if the secondary insurer (who is also my employer) does not submit an EOB at all? Any input you can offer would be awesome!
    Your secondary carrier should require an EOB from the primary carrier, not the other way around, unless there was some "debating" between the two carriers as to which one was "primary." Again, the hospital should do what they can to rectify the situation (prove timely filing and submit the EOB(s) as required) so that they will be paid. If the hospital is unable or unwilling to do so, then you should not be responsible for the portion of the bill(s) that insurance would have paid.

    The timely filing deadline varies for each insurance carrier. Secondary claims have a filing deadline that begins from the date on the primary EOB, not the date of service, so there is some leeway there. I would contact each insurance carrier & inquire as to the status of each claim, then let them know you are in collections because of filing deadline issues and see how they can help you. Good luck.

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