My insurance denied a medical bill claim for not being filed on time. Am I responsible?

March 16, 2015
I went to the ER and provided them at the time of service with my insurance card and they made a copy of it. The hospital billed my insurance for the ER visit and got paid. However, the doctors in the ER, who billed my insurance separately, did not get paid. They contacted me for the first time after 5 months asking for the full amount. I...

Advisor answers

Oh no! So many mistakes are made in medical billing---and they always become our headache instead of the provider!

Have you spoken to the business manager of the ER doctor's group? Sometimes, you have to go up the chain of command and keep asking (nicely, but assertively) if they can dismiss your bill based on their mistake. Most ER doctor groups keep merging, so it might take a little internet searching to discover who the main owner of the group might be---but sometimes that can pay off by getting to the top office ...

Here are 3 additional approaches: 1. If the provider billing you now is contracted with the insurance, they cannot bill you unless the insurance EOB shows they can. Most provider contracts with insurances prohibit billing the patient for untimely claims. Check the EOB, and call the insurance to report improper billing if this is the case.The insurance will contact the provider and order them to stop billing you. If this is unsuccessful, after 30 days the insurance can start more aggressive action leading to a potential contract termin...