Fair Billing?

[credit_on_mars]

Information on billing practices is hard to find. This is just a question about a billing. I received an EOB (health Ins statement) indicating that my Ins company refused to allow a billing from some diagnostic lab for a blood test done over a year ago. The lab did not submit the request until a year later. I would think a year is a little too log to now attempt to bill my insurance company and can these people now bill me after so long? At any rate they will play hell gettign me to pay it.

[Recovering Attorney]

You start with your carrier. You can appeal the denial. SOmetimes your AG or state insurance dept will help arbitrate disputes with your carrier, too.

[credit_on_mars]

What I meant to ask was how long do these labs, etc., have to bill a person? Is there a limit to how long they can wait until billing a person?

I tink a year is too long to wait, especialy afetr looking at the EOB and researching some unknown lab, I thought it was bogus but my doctor's office sent it them by mistake. They tend to be slow but there must be a time limit.

[Guest]

Ususally 1 year is the time frame.

If they fail to file the claim within 12 months the insurance will deny it.

You write a letter to the lab/doctor and tell them that this is THEIR mistake. They had your info and waited past the time limit to file.

They failed to mitigate their damages and therefor you are not liable to pay for their poor planning and mistakes.

[KentWA]

There are a lot of Carriers that now limit a provider from submiting a claim longer than 3 to 6 months. HOWEVER it is in their contract and if they did not submit it properly they failed to mitigate their damages.

[credit_on_mars]

Thanks all. I love in a two doctor town and he is a friend at that. His ever changing staff makes these mistakes so I told them we would be gong down the street to a lab that is covered by my insurance. Anyway, this is not the first time and we have EOB’s from another lab from four years ago, but they do not have anyone on their staff that speaks English so it is hard to get it across to them I do not intend to pay them. I live in Florida and this language problem increases by the minute. At any rate the lab never bills me and apparently they do not send it to collections so they just have to eat the fee.

[dpgirl]

In your case I am making the assumption that this lab is contracted with your insurance company. If so they have a contracted time frame in which to bill your insurance. Per their contract if they don't, they cannot bill you. Contact your insurance company to verify this information, get the name of the contact there just in case you should receive a bill from the lab.

Health insurance is very confusing for the consumer. Just to clarify a point, there is no actual time frame in which to bill an insurance. It varies per insurance carrier and whether or not the provider is contracted. Each contract will have a different time frame. There is no universal time frame. There is of course a reasonable time frame and one year is way too long. It is in the providers best interest to bill ASAP in order to get their money.

Your point is well taken regarding the staff at many providers. They just don't know what is going on. You cannot rely on them to give you the correct information. This is what happens when providers insist on paying minimum wage to their staff, they get what they pay for.

[credit_on_mars]

My Ins co. turned the lab down because they were not contracted with my company. I guess someone at my doctor's office sent it to this lab without telling us because they usually send it locally to a lab that is covered by my Ins. Anyway called the Ins Co. and they are not paying the Lab and told me not to worry about it since they had not responded to their query. My doctor is great but he can’t seem to keep office help. It is a small town and that is a typical operation. So, when I go for a blood test I just tell them to write a script and I’ll go to the local lab. They did this about 4 years ago and my doctor called them but even with fair Spanish he just could not get those Cuban-types to understand. They never billed me. They can whine all they want but after a year they will get nothing from me.

Yes, health insurance can be confusing – to us and them. I will not worry about it but was curious.

Thanks.....