fighting the collections beast
December 13, 2011 2:43 PM   Subscribe

Hospital bill collection blues. Am I in the legal right here?

Went to the ER. Didn't have my insurance info on me at the time, so I temporarily registered as a self-pay, and they told me I could get them my information afterwards. I ended up getting them that information approx. two and a half months later. The filing deadline for my insurance company was three months. When I receive a bill for the full cost of the medical procedure, I find out that not only did they not file in time, but they filed two months after I gave them the information. This has just now gone to collections.

Who's in the right? I understand that it wasn't wise to wait so long, but from my perspective someone at their hospital presumably gets paid to make sure they are on top of sending insurance information out. If they had two weeks to do so, it's not my problem that they dropped the ball. I dropped the ball in a way, too, but that fudge factor is the reason the insurance company has a filing deadline of three months rather than two days, right?

Who should be legally responsible for the costs? And more importantly, regardless of that, do I have any chance fighting this? I called the collections agency to politely but firmly explain my dispute as soon as I heard from them, and I am sending them a written dispute ASAP as well.

This is a non-trivial amount of money, not the kind where you can suck it up and pay off just to be rid of the annoyance. This happened in Massachusetts, if it matters. YANML.
posted by anonymous to Work & Money (9 answers total)
I you failed to meet deadlines to file the claim, you are responsible for the costs, I don't think you can "dispute" the charges, there is nothing to "dispute". The problem is not with either the ER/hospital nor the collection agency.

The "two weeks" is NOT long enough in terms of the hospital taking your information and turning it around, that can often take months.

You should certainly contact your insurance company and hope for some compassion and reason on their part.
posted by tomswift at 2:50 PM on December 13, 2011

I searched a little and found this blog post, it may be helpful for you. It sounds like you may need to file an appeal with the insurance company to contest the denial.
posted by insectosaurus at 3:37 PM on December 13, 2011

I agree with "tomswift" in that your primary recourse is the insurance company--beg, plead, cajole, cry--I doubt if threats will get you anywhere with any of these parties.
posted by rmhsinc at 3:38 PM on December 13, 2011

Nthing that you should contact the insurance company and file an appeal. I'd probably even go so far as to say, "Had I known that the hospital was going to miss the deadline, I would have tried to file the claim myself/contacted them repeatedly/etc."
posted by youngergirl44 at 3:50 PM on December 13, 2011

In some states, the hospital becomes responsible for the deadline in filing the claim as long as you gave them the information in time. Have you talked to the hospital? Will they communicate with you at this point? It may simply be a matter of them contacting the insurance company to tell them that the information was submitted on time, and this might be good enough for the insurance company.
posted by SpacemanStix at 3:52 PM on December 13, 2011

Since it's a significant chunk of money you need to spend some time familiarizing yourself with the HIPAA and your state laws re: medical billing.
posted by hamsterdam at 6:22 PM on December 13, 2011 [1 favorite]

if it's a significant amount of money, why are you trying to do this without a lawyer's help? You may have several legal defenses that you're about to unwittingly blow.

Any consumer lawyer ought to be able to help.
posted by mikewas at 7:12 PM on December 13, 2011

Ugh. I went through something similar (hospital made an error on the paperwork, then the instance company denied the claim). In my situation, it took about 7 mos to resolve, and i was sent to collections. However, as i was covered by the terms of my insurance, ultimately they paid.

Bottom line: your situation merits instance coverage under your policies' terms (right?). Now how do you prove it? Be your own advocate. Appeal to your insurance and provide documentation of the date you submitted the paperwork. Appeal to the hospital to confirm and provide documentation of when they received the paperwork vs when they processed the paperwork. Write down the name, date, time, and phone number of everyone you speak with. don't stop until you're covered.
posted by samthemander at 7:46 PM on December 13, 2011

I wrote a letter to an insurance company to appeal a "timely filing" denial for an ambulance ride where the ambulance folks never submitted a billing to either me or the insurer but rather sent it directly to collections a year after the charges were incurred.

In the appeal letter I explained the circumstances and included some quotes I found on the web about others complaining about this same ambulance company doing the same thing to them, too.

A couple of weeks later I got a letter granting my appeal! And it was sympathetically written, too. So, my experience tells me to try the appeal 'cause you just never know.
posted by bz at 10:11 PM on December 13, 2011

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