Is there a time limit for medical billing?

[SusanBAnthony]

We just got a medical bill for DS for last august.  As in 2012.  It is a billing nightmare with our insurance, since we are no longer on the same insurance.  As of now, they say we wore the whole amount.

DH and I feel outrage that they can just bill us 17 months later like it is no big thing.  The billing person was defensive and crabby, and told DH to just pay it now because you will end up owing it so don't waste your time fighting it.  


So, here I am asking if anyone knows if there is a reasonable time limit that they are expected to bill within.  

[lime]

I've gotten medical bills that were over a year from the date of service, including ones that just required co-pays.

[niq]

Can you try setting up a three-way call between the provider and the insurer?

Are there medical debt consultants (or whatever that job is that was mentioned in the big Time article about medical bills) in your state that you could contact? They may be able to give you some quick free/cheap advice over the phone on how to proceed.

[mskitkat]

Over my 11 month (and counting!) fight to desperately try to get a medical bill covered by my insurance company, I've concluded that medical insurance and billing was designed to make the patient cry as often as possible.

[dragonfly08]

I don't know if there are any specific regulations, but my sister got a bill for the birth of one of her kids almost two years later, and the upshot of her looking into it was that it was legit for them to bill her and she was required to pay it, despite the time lapse.

It sucks, IMO, that they can do that, and I'm sorry you have to deal with this.

[4speedy]

My mom just got a bill from when my dad was in the hospital 2 years ago. It was for $63. She was kind of mad that they sent it at all, considering it was from the day he died and she thought that after 2 years, they had finally stopped nickel and dimming her. She ended up paying because it just makes her too sad to deal with it. She gets another bill every 4-6 months from that same hospitalization.

[osulori]

Could it be that your insurance initially covered it then realized that for whatever reason they weren't supposed to and rescinded it? Aggravating but unfortunately all too common.

[SusanBAnthony]

Dec 9, 2013 20:09:12 GMT -5 osulori said:

Could it be that your insurance initially covered it then realized that for whatever reason they weren't supposed to and rescinded it? Aggravating but unfortunately all too common.

Unlikely because they are evil, and would never pay anything accidently.  They might accidentally not pay something they are supposed to, though.  

At at the time of the bill we had anthem (EVIL), now we are on Cigna, and I just found out wee are switching back to anthem next year.  Words cannot express my horror at the thought.

Anyway, at this point all we have spoken to is the billing person.  I need to call the provider.  To further complicate all of this, I think this bill should be covered under BCMH, if you are familiar with that, but who knows if they will still pay given it is been a year and a half.  Kill me now.

[Crazy Latina]

Apparently not since I was billed 2 years after the service.   They said they sent a few unanswered bills. Weird cause I never got them. 

[osulori]

Dec 9, 2013 20:14:52 GMT -5 SusanBAnthony said:

Dec 9, 2013 20:09:12 GMT -5 osulori said:

Could it be that your insurance initially covered it then realized that for whatever reason they weren't supposed to and rescinded it? Aggravating but unfortunately all too common.

Unlikely because they are evil, and would never pay anything accidently.  They might accidentally not pay something they are supposed to, though.  

At at the time of the bill we had anthem (EVIL), now we are on Cigna, and I just found out wee are switching back to anthem next year.  Words cannot express my horror at the thought.

Anyway, at this point all we have spoken to is the billing person.  I need to call the provider.  To further complicate all of this, I think this bill should be covered under BCMH, if you are familiar with that, but who knows if they will still pay given it is been a year and a half.  Kill me now.

Oof...they miiiiight even if the date of service was before the BCMH coverage started.  What is Anthem refusing to cover?

[SusanBAnthony]

Dec 9, 2013 20:33:16 GMT -5 osulori said:

Dec 9, 2013 20:14:52 GMT -5 SusanBAnthony said:

Unlikely because they are evil, and would never pay anything accidently.  They might accidentally not pay something they are supposed to, though.  

At at the time of the bill we had anthem (EVIL), now we are on Cigna, and I just found out wee are switching back to anthem next year.  Words cannot express my horror at the thought.

Anyway, at this point all we have spoken to is the billing person.  I need to call the provider.  To further complicate all of this, I think this bill should be covered under BCMH, if you are familiar with that, but who knows if they will still pay given it is been a year and a half.  Kill me now.

Oof...they miiiiight even if the date of service was before the BCMH coverage started.  What is Anthem refusing to cover?

Anthem refused to cover some stuff from Dh's triple bypass, even though they covered everything else, so we had long since met our deductible.  I called probably ten times, and finally just refused to get off the phone until I had a supervisors name and phone number to call back directly.  Magically they then paid the claim in 3 days.  Then I had another late bill that they refused to pay for my IUD, and I just gave in and paid that one, since I was only about 50% sure I would win it! and it decided it wasn't worth the headache.  

The bill that we just got sent should be covered by the bcmh, as I believe it was within the window.  But it has been so long that I am honestly not sure.  I need to pull out all the paperwork and look through it all, as I am only about 70% sure I even know what it is for. 

[KaraOrNot]

I got a bill 8 months after an appointment and was annoyed. I called the billing department and was told they have one year to bill. I have no idea if this is a law, a hospital policy, etc.

[Stingyshark]

In rare cases (like one that I can think of right off the top of my head) I've fought with an insurance for a year to pay a claim; if there had been a patient portion, it would have been over a year before I could bill the patient.

I'm not aware of any laws that say we have to bill the patient within a certain time frame.

[midnightmare81]

My first step would be to check with your insurer to find out if they ever sent the bill to them. Many companies have timely filing limits. So if the provider never sent the bill for a covered service to the ins, they can not then bill the patient instead.

That said, if they did bill your ins and they were fighting all this time to get it covered and finally no more will be covered, then they can bill you. I am not aware of any laws that limit how long a provider has to bill from DOS.

[Stingyshark]

Dec 9, 2013 22:50:53 GMT -5 midnightmare81 said:

My first step would be to check with your insurer to find out if they ever sent the bill to them. Many companies have timely filing limits. So if the provider never sent the bill for a covered service to the ins, they can not then bill the patient instead.

That said, if they did bill your ins and they were fighting all this time to get it covered and finally no more will be covered, then they can bill you. I am not aware of any laws that limit how long a provider has to bill from DOS.

All of this.

Depending on the insurance we have different timely filing limits- most of them are 90 days. There are a few that are 180, and Medicaid / Medicare are 1yr.

[SusanBAnthony]

Dec 9, 2013 22:50:53 GMT -5 midnightmare81 said:

My first step would be to check with your insurer to find out if they ever sent the bill to them. Many companies have timely filing limits. So if the provider never sent the bill for a covered service to the ins, they can not then bill the patient instead.

That said, if they did bill your ins and they were fighting all this time to get it covered and finally no more will be covered, then they can bill you. I am not aware of any laws that limit how long a provider has to bill from DOS.

DH said the billing person admitted that this bill "slipped through the cracks" so I am guessing it is scenario 1, not scenario 2.  In which case we may have a leg to stand on.  

I have yet to get ahold of a live person who can help me, I need to dig up the old insurance cards and call the insurance company.  Which is always a super fun 15 minute fight with their automated phone system, before I am even put on hold, let alone talking to a live person.  FML.

[Stingyshark]

Dec 10, 2013 11:15:27 GMT -5 SusanBAnthony said:

Dec 9, 2013 22:50:53 GMT -5 midnightmare81 said:

My first step would be to check with your insurer to find out if they ever sent the bill to them. Many companies have timely filing limits. So if the provider never sent the bill for a covered service to the ins, they can not then bill the patient instead.

That said, if they did bill your ins and they were fighting all this time to get it covered and finally no more will be covered, then they can bill you. I am not aware of any laws that limit how long a provider has to bill from DOS.

DH said the billing person admitted that this bill "slipped through the cracks" so I am guessing it is scenario 1, not scenario 2.  In which case we may have a leg to stand on.  

I have yet to get ahold of a live person who can help me, I need to dig up the old insurance cards and call the insurance company.  Which is always a super fun 15 minute fight with their automated phone system, before I am even put on hold, let alone talking to a live person.  FML.

Do you have access to your EOBs on the insurer's website? If so, that might say whether or not the claim was denied for timely filing. 

Sorry you're having to deal with all that - medical billing is a nightmare, and that's what I do for a living =/

[karenj]

Hospitals have longer. We have anywhere from 60days to 1 year depending on insurance with the Doctor's office. A friend had a hospital stay and the hospital told her they had up to 15 months to bill.

[karenj]

And than insurance has 45 days to process it but they could prolong that by asking for more information.