Health Care Service Provider Timely Billing to Patient

[quincy]

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.

The EOB does not always include the specific services provided or the specific balance (for privacy reasons). It depends on the insurance company’s policy. So a patient must wait for the bills.

I believe CorollaRandy is taking a good step in speaking to his insurer first.

 

[zddoodah]

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

What are you surprised about? Do you think part of my statement was not correct?

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.

I disagree, and you explained exactly why. And, even if this were correct, it wouldn't make what I wrote incorrect.

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.

Whether something is or isn't a "surprise" isn't legally relevant, and the fact that an EOB isn't a bill has nothing to do with whether something is or isn't a surprise. The whole point of an EOB is to give you notice of the portion of the bill for which you may be personally responsible. As for not knowing how to pay, are you kidding? If you get an EOB on day zero, you know that you may be billed for $X. If you don't get a bill within a few weeks, you call the provider and say, "hey...are you going to bill me for this?"

And...just to be clear...none of this has anything to do with the validity of the bill. Look at it this way: If the bill had been sent immediately after the services were rendered, you'd have been out the money. Instead, you had the benefit of not having to pay for a year and a half (basically, 18 months of no payment due, no interest financing).

 

[quincy]

There can be problems with late-billing which is why I urge some caution about simply paying the bill.

I think “surprise” can be a legitimate word to use in light of the “no surprises act” which makes some billing by some providers open to more questions than before.

 

[PayrollHRGuy]

There can be problems with late-billing which is why I urge some caution about simply paying the bill.

I think “surprise” can be a legitimate word to use in light of the “no surprises act” which makes some billing by some providers open to more questions than before.

The OP has not mentioned anything that would trigger protection under the No Surprises Act.

 

[quincy]

The OP has not mentioned anything that would trigger protection under the No Surprises Act.

The medical services apparently were provided by in-network providers but I still don’t think it especially smart to just pay the bill. The insurance company should be able to offer some assurance that the bill is legitimate. And, again, the balance owing possibly could be negotiated lower.

 

[doucar]

The insurance company should be able to offer some assurance that the bill is legitimate.
They did with the EOB.

 

[PayrollHRGuy]

The medical services apparently were provided by in-network providers but I still don’t think it especially smart to just pay the bill. The insurance company should be able to offer some assurance that the bill is legitimate. And, again, the balance owing possibly could be negotiated lower.

I never wrote differently but twice in this thread you have responded suggesting the "No Surprises Act" may be of some use to the OP and even a cursory reading of the law shows that nothing the OP has written would back such a postition.

 

[Zigner]

Agreed - this is not the type of situation that the "No Surprises Act" is designed to address.

From https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills:

As of January 1, 2022, consumers have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.


Previously, if consumers had health coverage and got care from an out-of-network provider, their health plan usually wouldn't cover the entire out-of-network cost. This left many with higher costs than if they’d been seen by an in-network provider. This is especially common in an emergency situation, where consumers might not be able to choose the provider. Even if a consumer goes to an in-network hospital, they might get care from out-of-network providers at that facility.


In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.


The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020 and contains many provisions to help protect consumers from surprise bills, including the No Surprises Act under title I and Transparency under title II. Learn more about protections for consumers, understanding costs in advance to avoid surprise bills, and what happens when payment disagreements arise after receiving medical care.

 

[quincy]

I think the link I posted earlier (Post #9) has links to the text of the Act. Oklahoma has its own, similar law.

 

[PayrollHRGuy]

I think the link I posted earlier (Post #9) has links to the text of the Act.

Yet you clearly didn't read or understand it.

Oklahoma has its own, similar law.

Unless it covers late billing it won't be any help to the OP.

 

[quincy]

Yet you clearly didn't read or understand it.



Unless it covers late billing it won't be any help to the OP.

I read and understood it just fine. I think it is important for CorollaRandy to read it and make sure that the bill he received did, in fact, come from an in-network provider and to make sure that the bill was not already partially covered by insurance.

Again, I find the long delay in sending the bill worth more attention than a more timely bill-receipt might warrant.

 

[CorollaRandy]

OK Department of Insurance says they are unable to help, again. BCBS gave me the same canned response as last time. Billing support number on the bill just rings and rings and rings. I called the practice, and advised what is going on, they added a note to my account that I'm looking into this matter, and they will not be moving my account to collections. I even asked that they have someone from billing reach out to me, and they said they can't do that as they have no way to ask someone to call me, it all goes through that number that just rings and rings and rings.

 

[quincy]

OK Department of Insurance says they are unable to help, again. BCBS gave me the same canned response as last time. Billing support number on the bill just rings and rings and rings. I called the practice, and advised what is going on, they added a note to my account that I'm looking into this matter, and they will not be moving my account to collections. I even asked that they have someone from billing reach out to me, and they said they can't do that as they have no way to ask someone to call me, it all goes through that number that just rings and rings and rings.

That has to be frustrating. At least your account will not be moving to collections (for awhile, at least), which buys you some additional time to consider whether to just pay the bill and be done with it, or continue to try to reach someone with the answers you seek.

Good luck.