Suddenly a medical bill appeared from 19 months ago?
October 1, 2024 4:30 PM Subscribe
How do we deal with a bill for orthopedic services that suddenly came in the mail after 19 months?
We thought this had been covered by Anthem, but now the provider does not accept Anthem. How do we search for evidence that they did indeed accept Anthem at the time of service? I can no longer find online the Anthem provider list for 2023. The service was in January of 2023, and the bill is $587, for treatment for a hockey injury at their orthopedic walk-in clinic. In talking with Anthem, they have no record of being billed although we presented my husband's card, which they indeed accepted at the time.
There seems to be a great degree of billing turmoil at this particular Orthopedic clinic.
What is the best way to proceed? I am unable to find any records online, either from Anthem or as to why they waited so long to bill us?
Any and all answers welcome! Thanks a bunch, hive-minders!
We thought this had been covered by Anthem, but now the provider does not accept Anthem. How do we search for evidence that they did indeed accept Anthem at the time of service? I can no longer find online the Anthem provider list for 2023. The service was in January of 2023, and the bill is $587, for treatment for a hockey injury at their orthopedic walk-in clinic. In talking with Anthem, they have no record of being billed although we presented my husband's card, which they indeed accepted at the time.
There seems to be a great degree of billing turmoil at this particular Orthopedic clinic.
What is the best way to proceed? I am unable to find any records online, either from Anthem or as to why they waited so long to bill us?
Any and all answers welcome! Thanks a bunch, hive-minders!
Does the bill you recieved recently have the date of service 01/2023 on it? If so, I would write back attaching a copy of the bill saying what you said here. This bill is from 10 months ago. At the time you accepted Anthem insurance. This bill should be sent to them. If it does not have the date of service on it, if you can get it in the patient portal or the like, get a copy that indicates date of service and write the same short paragraph about this being Anthem's responsibility. I would also do as stated above, talk to HR if there is an HR to talk to.
And, as an adult hockey player, I know how the injuries can pile up. I hope they are recovered and that they won the game!
posted by JohnnyGunn at 5:28 PM on October 1 [1 favorite]
And, as an adult hockey player, I know how the injuries can pile up. I hope they are recovered and that they won the game!
posted by JohnnyGunn at 5:28 PM on October 1 [1 favorite]
It depends on your state, but in some states, there are laws that require bills to be sent within a certain timeframe from date of service. Probably worth a search.
posted by purple_bird at 5:49 PM on October 1 [2 favorites]
posted by purple_bird at 5:49 PM on October 1 [2 favorites]
In certain states, this would qualify as a "surprise bill" that you would have some protection against.
posted by ThePinkSuperhero at 5:52 PM on October 1 [1 favorite]
posted by ThePinkSuperhero at 5:52 PM on October 1 [1 favorite]
Anecdotally, it seems like some urgent cares pop up and start seeing patients before their insurance enrollments come through. They hold claims pending enrollment any then start dropping stuff once the effective date is confirmed, leaving some patients stuck OON after the fact. Raise a stink!
posted by ThePinkSuperhero at 5:56 PM on October 1 [2 favorites]
posted by ThePinkSuperhero at 5:56 PM on October 1 [2 favorites]
You have at least three different defenses here:
1. They told you that they were in-network with Anthem and you gave them your card. If, as it looks like, they failed to bill Anthem in a timely fashion and Anthem refused to pay, you should not be liable since you had valid coverage with Anthem. If they say you have to pay when they never filed the claim, they are probably violating their contract with Anthem. If they still insist after you tell them this, call Anthem and get them involved. [May have limited effectiveness since they are no longer within network but worth a try]
2. If they didn't take Anthem and they knew that you were going to pay out of pocket then they were required to give you a Good Faith Estimate of Charges. They obviously failed to do this which gives you some remedies, including I think the right to collect some money from them for damages. Google this to find out more.
3. Search for [your state] law timely medical billing. In California for example medical bills must be submitted within 12 months for date of service or date of discharge. Remind them of this, citing the specific law and threaten to pursue this the state Department of Insurance (or whoever oversees this in your state)
Send them a letter outlining all the reasons why this ridiculous and threaten to pursue it the approriate authorities if they continue to try to collect. Hopefully that will make them go away. If not, then you have some idea of what to do next.
posted by metahawk at 7:45 PM on October 1 [7 favorites]
1. They told you that they were in-network with Anthem and you gave them your card. If, as it looks like, they failed to bill Anthem in a timely fashion and Anthem refused to pay, you should not be liable since you had valid coverage with Anthem. If they say you have to pay when they never filed the claim, they are probably violating their contract with Anthem. If they still insist after you tell them this, call Anthem and get them involved. [May have limited effectiveness since they are no longer within network but worth a try]
2. If they didn't take Anthem and they knew that you were going to pay out of pocket then they were required to give you a Good Faith Estimate of Charges. They obviously failed to do this which gives you some remedies, including I think the right to collect some money from them for damages. Google this to find out more.
3. Search for [your state] law timely medical billing. In California for example medical bills must be submitted within 12 months for date of service or date of discharge. Remind them of this, citing the specific law and threaten to pursue this the state Department of Insurance (or whoever oversees this in your state)
Send them a letter outlining all the reasons why this ridiculous and threaten to pursue it the approriate authorities if they continue to try to collect. Hopefully that will make them go away. If not, then you have some idea of what to do next.
posted by metahawk at 7:45 PM on October 1 [7 favorites]
Does the bill you recieved recently have the date of service 01/2023 on it? If so, I would write back attaching a copy of the bill saying what you said here. This bill is from 10 months ago.
This bill is from 21 months ago. That is more than a year and a half. I would ask them why they didn't submit it to insurance and ask Anthem for help in getting a list of providers from early 2023.
posted by soelo at 9:23 PM on October 1 [1 favorite]
This bill is from 21 months ago. That is more than a year and a half. I would ask them why they didn't submit it to insurance and ask Anthem for help in getting a list of providers from early 2023.
posted by soelo at 9:23 PM on October 1 [1 favorite]
There theoretically should be an easy way for a consumer to resolve this issue.
In practical terms though, you are not the customer of the insurance company - the organization who selected the policy (perhaps your employer) is the customer. I wholeheartedly recommend bringing this to HR for help. HR will forward your email to the internal benefits team; the internal benefits team will forward it to their health insurance broker/advisor; they will forward it to the insurance company’s client services team; and that client services team will open a ticket and then get back to you with next steps. This sounds circuitous but given the way these systems are designed, this is almlst certainly the most efficient way for you to get an answer.
posted by samthemander at 9:38 PM on October 1
In practical terms though, you are not the customer of the insurance company - the organization who selected the policy (perhaps your employer) is the customer. I wholeheartedly recommend bringing this to HR for help. HR will forward your email to the internal benefits team; the internal benefits team will forward it to their health insurance broker/advisor; they will forward it to the insurance company’s client services team; and that client services team will open a ticket and then get back to you with next steps. This sounds circuitous but given the way these systems are designed, this is almlst certainly the most efficient way for you to get an answer.
posted by samthemander at 9:38 PM on October 1
It might not hurt to give the doctor's office a quick call. I once got a dentist bill 3 years after the fact--and after I had switched jobs and had completely different insurance. I asked them if the bill was for real and it turned out they had a shady medical biller that didn't bill anyone for years and as soon as I called they just removed it for me.
posted by shornco at 7:47 AM on October 2
posted by shornco at 7:47 AM on October 2
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posted by phunniemee at 4:53 PM on October 1 [7 favorites]