provider/insurance contract does exist!

[sukharev]

What is the name of your state?Texas

Since original thread got locked (whoever does this should be a bit more considerate to OPs), here is the useful link in reply to JETX's claims that there is no contract for providers:

http://204.65.38.3/consumer/doctors4.html

Under contract, providers cannot bill patients, only insurance, and within 10 month in that case. While this is for Texas (and in its LAW), I am pretty sure the rest of the country does something similar.

 

[justalayman]

What is the name of your state?Texas

Since original thread got locked (whoever does this should be a bit more considerate to OPs), here is the useful link in reply to JETX's claims that there is no contract for providers:

http://204.65.38.3/consumer/doctors4.html

Under contract, providers cannot bill patients, only insurance, and within 10 month in that case. While this is for Texas (and in its LAW), I am pretty sure the rest of the country does something similar.

From Mi here. Don't know if it is law but I do know that BC/BS ins has contracts with PPOs. I have had several times where ins. said there would be NO payment to provider for whatever reason. Provider dumps it. No charge to me.
Other nice bene no bill to me until EOB released. Both as contractual obligation.

Although JETX did have a point. the OP never stated if they had HMO PPO or any other alphabet that would apply. I suspect OP did have insurance with contractual obligations between them and med provider but never gave that info (that I remember)

 

[somarco]

Out of network claims are not subject to the same time limits on filing as in network claims. If the provider has not signed a contract with the carrier the obligation to pay the charges falls on the patient.

 

[usaohol]

What is the name of your state?Texas

Since original thread got locked (whoever does this should be a bit more considerate to OPs), here is the useful link in reply to JETX's claims that there is no contract for providers:

http://204.65.38.3/consumer/doctors4.html

Under contract, providers cannot bill patients, only insurance, and within 10 month in that case. While this is for Texas (and in its LAW), I am pretty sure the rest of the country does something similar.

I don't believe that JETX was disputing that contracts exist between providers and insurance carriers only that there is a question in the initial thread as to whether or not the hospital the patient went to had a contract with the insurance carrier- there is no proof of that. JETX please correct me if I am wrong.

Whether or not a patient is responsible for a bill after insurance denies for timeliness depends upon the terms of the contract. Most insurance carriers have a clause in their contracts with providers preventing them from billing the patient when a claim is not filed timely, but not all.

"Under contract, providers cannot bill patients, only insurance" again this is dependant on the terms of the contract between the insurance carrier and hospital.


Q: Can I bill my patients´ insurance companies or HMOs whenever I choose?
A: No. You must bill the insurance company or HMO within 10 months after providing services. If a provider is under contract with a health plan, then the billing deadline set by the contract prevails over the 10-month general deadline. Similarly, if a provider is required or allowed to directly bill a third-party payor or operating under federal or state law, including Medicare and Medicaid, the contract deadline prevails

 

[somarco]

IF the provider is a non-network provider, no contract exists between the provider and the carrier. The insurance contract may indeed place a limit on filing of claims which binding with the insured.

When a provider accepts assignment of benefits it is still the responsibility of the insured to see that claims are submitted and paid in a timely fashion. Failing that, the one who receives treatment and signs for financial responsibility is the one who will ultimately pay for services rendered.