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Advice on Medical Bills and Insurance Claims - The Bills.com Blog
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Advice on Medical Bills and Insurance Claims
Wednesday, Apr 8, 2009
Question: Upon reviewing my credit report I found numerous negitive medical bills on my report, after further investigation...I found out that the providers had not submitted the claims to the correct administrators even after recieving info from Insurance company...Since my employer has changed carriers the previous carrier will not pay claims (they say). Do I have legal right to ask them to be removed since I have no control over the filing of these claims???
Answer: Honestly, you probably do not have any legal right to force that these debts be removed from your credit report, because, from the information you have provided, it sounds like you are probably liable for the debts. Regardless of any issues you may have had with your insurance, you are ultimately responsible for payment for any medical services provided to you, even if the bill resulted in a mix-up regarding your insurance information. The medical provider will likely make the argument that you were responsible for notifying the provider of the new insurance information, or that you should have paid the bill and filed insurance claims yourself. A medical provider is rarely, if ever, required to file an insurance claim on a patient’s behalf; providers do this as a courtesy to patients and to help insure that they are paid in a timely manner. However, if the provider was unable to file the claim, whatever the reason, you are responsible for the debt. Once you pay the debt, you can file a claim with your insurance provider which should reimburse
you, assuming that your claims meet filing deadlines and other requirements.
In this case, it sounds as if your previous insurance provider is refusing to pay these claims because they were filed outside of the time limits laid out in your policy. If, for example, the claim was filed timely but rejected, and then refilled after the deadlines, then the insurance company may be required to pay the claim as the delay would have been due, at least in part, to its improper rejection of the initial claim. However, if you or the provider simply failed to file the claims in a timely manner, then the insurer may be within its rights to refuse to pay these claims. Regardless of the reason given by the insurance company for its denial, you have the right to appeal the decision if you feel that the claim should have been paid under the terms of your policy. To read more about the insurance appeals process, and various other insurance related topics, you should visit http://www.claims-advocacy.org/.
Another issue may be what representations the provider made to you about your responsibilities in paying for its services. For
In this case, it sounds as if your previous insurance provider is refusing to pay these claims because they were filed outside of the time limits laid out in your policy. If, for example, the claim was filed timely but rejected, and then refilled after the deadlines, then the insurance company may be required to pay the claim as the delay would have been due, at least in part, to its improper rejection of the initial claim. However, if you or the provider simply failed to file the claims in a timely manner, then the insurer may be within its rights to refuse to pay these claims. Regardless of the reason given by the insurance company for its denial, you have the right to appeal the decision if you feel that the claim should have been paid under the terms of your policy. To read more about the insurance appeals process, and various other insurance related topics, you should visit http://www.claims-advocacy.org/.
Another issue may be what representations the provider made to you about your responsibilities in paying for its services. For
example, if the provider told you repeatedly that the debt was already paid by your insurance, and you therefore did not file a claim based on this representation, then the provider may be liable for all or a portion of the unpaid debt. However, if the provider sent you a bill in a timely manner that indicated that the insurance company had not paid the bill, you would likely have been responsible for making sure that any errors were corrected, and for paying the bill if the provider was still unable or unwilling to pay it on your behalf, then the lender’s attempts to collect on this debt and its placing the item on your credit reports are likely acceptable practices, and you will need to resolve the debt directly with the provider if you want these items removed from your credit reports.
For more information about credit, credit reports, and credit scoring, I encourage you to visit the Bills.com credit resources page at http://www.bills.com/credit/. I wish you the best of luck in your efforts to resolve this debt, and hope that the information I have provided helps you Find. Learn. Save.
Best,
Bill
www.bills.com/blog/
For more information about credit, credit reports, and credit scoring, I encourage you to visit the Bills.com credit resources page at http://www.bills.com/credit/. I wish you the best of luck in your efforts to resolve this debt, and hope that the information I have provided helps you Find. Learn. Save.
Best,
Bill
www.bills.com/blog/
Also, make sure to get a free financial health check-up with Bills IQ!
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1. Posted by Curt on Saturday 11th July 2009 09:56
I have a very similar situation. I had a small medical bill that was not paid by my insurance company. I appealed to the insurance company because they did not pay the bill becuase the procedure was not pre-approved. Eventually the bill was paid by the insurance company. The insruance company paid the hospital. During the appeals process with the insurance company, the item was turned over to a collection agency and reported to the credit reporting companies (equifax, etc.) The item now shows up on my credit report as a paid collection. Can I get this item removed since the insurance company paid the bill (just late after appeals?)
2. Posted by Bill on Monday 13th July 2009 08:21
Yes, I recommend you make copies of the paperwork involved, including the back-and-forth between you and the insurance company, and the insurance company's notice that the bill would be paid. Please see Information on Credit Letter of Deletion for how to notify the credit reporting agencies of the error.
3. Posted by Sharron Fauber on Thursday 1st October 2009 05:53
If a patient has medical insurance with a high deductible and does not want it filed are we legally obligated to file to the carrier.The patient just wanted to pay the charge out of their pocket and said to just forget about fooling with insurance.
4. Posted by Bill on Thursday 1st October 2009 08:46
If there is any legal obligation to file a claim, it would be found in a contract between the insurance company and the insured. I cannot imagine that a medical service provider would have a legal obligation to file an insured patient's charges to the insurance company if the patient told them not to, but I suppose stranger terms and conditions could be written. I recommend you consult with the person responsible at your company who negotiates contracts with insurance carriers.