Health Care Service Provider Timely Billing to Patient

[CorollaRandy]

What is the name of your state? OK

I have been searching for weeks without any luck, and even contacted BCBS of OK (Insurance I have through my work), and the OK Dept. Ins, none of them can answer this question.

How long do Health Care Service Providers have to bill a patient, before they cannot attempt to try and collect? FWIW, in TX, it's the 1st day of the 11th month after services were provided, but this doesn't really help me out much as both the health care provider and myself are in OK.

I'm sure I'm not searching for the correct keywords, etc.. when doing my own searches.

Any assistance would be greatly appreciated, in advance.

Thank you!

 

[quincy]

https://www.oid.ok.gov/nsa/

The Oklahoma Insurance Department should be able to answer your question. I suggest you try the department again.

 

[zddoodah]

How long do Health Care Service Providers have to bill a patient, before they cannot attempt to try and collect?

No such time limit exists. One can attempt anything at any time. After the statute of limitations expired, a creditor may no longer sue successfully, but the creditor can still attempt to collect.

FWIW, in TX, it's the 1st day of the 11th month after services were provided

Sort of. See Tex. Civ. Prac. & Remedies Code section 146.003.

Oklahoma has no such law.

 

[adjusterjack]

How long do Health Care Service Providers have to bill a patient, before they cannot attempt to try and collect?

Theoretically, indefinitely.

After the statute of limitations expired, a creditor may no longer sue successfully, but the creditor can still attempt to collect.

I'm surprised, Z, you usually take great pains to make correct statements.

A statute of limitations is a time limit for filing a lawsuit and it typically starts running when a contract is breached. If the creditor doesn't doesn't bill then there is no breach. Granted, there are signs all over the provider's walls saying payment is due when services are rendered and the patient often signs something to that effect. But, still, if the provider doesn't present those charges to the patient, then there is no breach until the bill is presented and not paid.

it's the 1st day of the 11th month after services were provided,

How often have you contacted the provider and asked for the bill or a copy of the bill?

With what result?

 

[quincy]

CorollaRandy, what is it that led to your question?

Are you waiting to be billed for a medical service that was provided, or did you just receive a bill for a medical service that was provided you quite awhile ago, or are you just curious?

 

[CorollaRandy]

About a week ago, I received a the first bill from an old medical service provider from early Dec 2020 (not a typo in the year).

 

[quincy]

About a week ago, I received a the first bill from an old medical service provider from early Dec 2020 (not a typo in the year).

I bet that was an unpleasant surprise.

What was the postmark on the envelope? Was there any indication on the envelope that the bill was originally sent to a wrong address or that the delay was due to a post office error?

Was this a bill from an out-of-network health service? Have you contacted the source of the bill for an explanation?

My initial reaction is that the bill has been sent too late for the sender to expect payment.

 

[CorollaRandy]

Very unpleasant surprise, as my wife got one as well, going back to the same dates.

Statement date of the bill inside was a few days prior to arrival, and I do not believe I still have the envelope it came in, however, it looked fresh with no additional writing on it, etc... This is all at home, and I am at work. As for in/out-of-network, all in-network health service. I called the doctor and they just kept rambling about how I got my EOB, so it shouldn't be a surprise. My argument was that the EOB isn't a bill, as it specifically states, and in no way explains how to pay my part. Doctor's office had no reply to that. Number on the bill never answers, as I get an automated reply saying my party is not answering and that the call will be disconnected, then hangs up on me.

Edit: Also, I wanted to thank you, and everyone else that took their time to reply, and assist. It is appreciated.

 

[quincy]

Very unpleasant surprise, as my wife got one as well, going back to the same dates.

Statement date of the bill inside was a few days prior to arrival, and I do not believe I still have the envelope it came in, however, it looked fresh with no additional writing on it, etc... This is all at home, and I am at work. As for in/out-of-network, all in-network health service. I called the doctor and they just kept rambling about how I got my EOB, so it shouldn't be a surprise. My argument was that the EOB isn't a bill, as it specifically states, and in no way explains how to pay my part. Doctor's office had no reply to that. Number on the bill never answers, as I get an automated reply saying my party is not answering and that the call will be disconnected, then hangs up on me.

Edit: Also, I wanted to thank you, and everyone else that took their time to reply, and assist. It is appreciated.

The “No Surprises Act” on medical billing went into effect in January 2022 but it seems to me that it still can apply to what you are describing. Here is a link to information about the Act:

https://www.hhs.gov/about/news/2022/01/03/hhs-kicks-off-new-year-with-new-protections-from-surprise-medical-bills.html

I suggest you turn the bills over to your insurer to handle, with perhaps a mention of how the “billing was a surprise.”

 

[adjusterjack]

I called the doctor and they just kept rambling about how I got my EOB, so it shouldn't be a surprise. My argument was that the EOB isn't a bill, as it specifically states, and in no way explains how to pay my part.

Wait. That's new.

You got an EOB at some point during the 11 months. The EOB (Explanation of Benefits) comes from your insurance company and shows you what was paid and how much your share is likely to be. That was your notice.

I disagree with Quincy. The bill was not a "surprise." The EOB was notice of a balance, billed or not billed.

You could have just sent a check based on the EOB.

I'd say you need to pay the bill or expect to get sent to collections.

Pay it and get over it.

 

[CorollaRandy]

Time of service was 17 months ago, I would have received the EOB about 16 months ago, advising how much I 'could' be charged. Bill comes a week ago. I'll call BCBS of OK, again, this time explaining what is going on (rather than asking my initial question), and see where to go from there. Then it's off to OK Dept. of Ins. after that.
Once again, thank you all. I will keep everyone posted.

 

[quincy]

Time of service was 17 months ago, I would have received the EOB about 16 months ago, advising how much I 'could' be charged. Bill comes a week ago. I'll call BCBS of OK, again, this time explaining what is going on (rather than asking my initial question), and see where to go from there. Then it's off to OK Dept. of Ins. after that.
Once again, thank you all. I will keep everyone posted.

Yes. Please keep us updated. If what you received was a bill, I think you should submit it to your insurer - but speaking to your insurer first is a good plan.

 

[Zigner]

Wait. That's new.

You got an EOB at some point during the 11 months. The EOB (Explanation of Benefits) comes from your insurance company and shows you what was paid and how much your share is likely to be. That was your notice.

Further to this - since the EoB was received, the OP should have been on the lookout for the bill and then followed up when it hadn't been received. Unfortunately, any statute of limitations discussions are useless as well, since the minimum period that might be applied appears to be 3 years (oral contract) or 5 years (collection of a debt on account).

 

[quincy]

Further to this - since the EoB was received, the OP should have been on the lookout for the bill and then followed up when it hadn't been received. Unfortunately, any statute of limitations discussions are useless as well, since the minimum period that might be applied appears to be 3 years (oral contract) or 5 years (collection of a debt on account).

The time limitation asked about was not for debt collection but rather for billing - that is, how long does a medical service provider have after a medical service has been provided to send a bill to the patient. And the answer to that question varies by state.

An EOB is not a bill. It is an explanation of what the insurance will cover. It is not used to pay any bill.

Because of the time between service and billing, it could be smart to ask the service provider to re-bill the insurer. It can also be important to check the bill received against the EOB amount due. And, finally, negotiating with the service provider for a lower amount could work to lower the obligation, this if it is determined that the bill is legitimate and the service provider is owed the money.

 

[Zigner]

The time limitation asked about was not for debt collection but rather for billing - that is, how long does a medical service provider have after a medical service has been provided to send a bill to the patient. And the answer to that question varies by state.

An EOB is not a bill. It is an explanation of what the insurance will cover. It is not used to pay any bill.

Yes, it varies by state and, as was pointed out above, it's not addressed in the OP's state.

C'mon Q - You know that I know what an EOB is, and you also know that the EOB lists that amount that is due from the patient to the provider. If the patient gets an EOB and never sees a bill, then it's not unreasonable to expect that the patient will follow up. I understand that many don't actually follow up in that situation, but that doesn't mean they shouldn't.