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My medical provider failed to bill my insurance company, am I still responsible for the debt?

Some common myths:

1. Medical providers are required to bill your insurance company.

2. Insurance companies have to pay your medical bills.

The truth is, you are responsible for paying your medical debts. Now, if you happen to have medical insurance, AND the insurance company receives the medical bill in accordance with its stated requirements AND the medical service is covered under the policy, then and only then is the insurance company responsible for paying the debt. Pay special attention to the words, “receives the medical bill in accordance with its stated requirements” because this is what gets people into trouble more often than not. As a convenience, most medical providers offer to bill your insurance company. However, accepting their offer does not relieve you of the responsibility of ensuring the medical bill gets paid. It’s not uncommon for medical providers to submit medical bills after an insurance company’s deadline for filing. In some cases, the provider may, for a number of odd reasons, not submit the medical bill at all. Regardless of the reason, the bottom line is that the consumer is still responsible for ensuring the insurance company “receives the medical bill in accordance with its stated requirements”! In some cases, your insurance company may reject the bill or flat out refuse to pay. The fact that your insurance company did not pay is not the medical provider’s concern! The medical provider has the right to expect you to pay the bill in a timely manner. You may have to argue with your insurance company and even go through dispute resolution but while you’re doing that, the medical provider is still entitled to timely payment. The best thing you can do is communicate with your medical providers to let them know you are working to resolve the issue. In the end, you may have to pay the provider yourself and then work with your insurance company to get reimbursed. Always read the medical provider paperwork (contract for services rendered) carefully!


confidential informationThere may be instances where discussing your situation over a public forum could potentially compromise your interests. On these occasions we will contact you directly via email in order to answer your inquiry in a confidential manner.

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  1. I disagree with this, yes you are responsible to be sure your ins process the claim. But, Contracted Ins companies have contracts with facilies, any proceedure must be pre approved by the ins. this information is obtained months prior to the actual date of service. In my case, I have a Work Comp ins who pays my upper extrimity, they must auth my svcs. I have a primary care phys thru my husb employer who is contracted with the facility should i need to be seen for any other part of my body, then i have medicare as a third insurance and most facilitys have contracts with medicare. example: If my er visit was due to my w/comp injury they would bill SRS with the er report, if they then recvd a denial stating it was not authorized, they can 1 appeal it as er visits are not subject to pror auth, or 2 bill my Contracted ins with a copy of the denial from w/comp. If my contracted ins denies it as w/comp it is the responsibility to take that denial and appeal to the w/comp ins. If neither want to pay it, they can bill it to medicare who will then deny it as workrelated…Now.. this is where the line of medical provider paperwork (contract for services rendered) is mishandled, hence the timely filing issue. I can call my ins company, and they will tell me what they are asking the facility for..ill call the facility and tell them what the ins told me & they tell me they will request the addtl information and mail it to the ins. a month later, your bills going to collections. call the facility explain 3 ins coverages All have contracts with facililty and all state primary paid more than 2ndary allows pt has no resp. another couple of months and pooof collection notice on the bal after the contract write of. total 164.00 what do collection agencys do with accounts under 300.00? send three notices and report it to credit file. But I called on the first notice explained the 3 ins carriers and bal should be a contract or mcare fee schedule adjustment. they say they will note the act. poof another notice. I call my atty, and prepair letter of dispute w/copies of ins eobs. hear nothing. 2 years later check my credit report and its there. and the disuptes now go to 3 credit reporting co. Nothing, No resp from facility reporting. 2 of the credit reporting co removed it as there was no longer any “documents” for they to revw..Transunion to this day has not removed this from my credit file. how much can I get if i choose to pursue suit..
    Thank You for your anticipated response
    Patty Schlegel

    • You may have experienced a violation of your rights under the FDCPA or FCRA. The Debt Help Lawyers at this site can provide you a free, no obligation Fair Debt consultation. Give us a call and let’s figure out how to get you some real help. 888-595-9111.

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