Ask Christina: What Can I Do About an Insurance Claim That Was Denied for Missing the Filing Deadline?

Health, Managing Health Insurance
Ask Christina

Question:

My insurance company denied coverage for a three-day, $68,000 hospital stay. They said the time limit for filing had been exceeded. I thought the hospital was responsible for filing these claims on time. I can’t afford this bill and don’t know what to do.

Answer:

I’m sorry to hear that you have been hit with such a significant bill. Hospital stays are expensive, and for the insured, a denial could spell financial disaster. A NerdWallet study found most personal bankruptcies in the U.S. are medical bankruptcies, and with just a few days in the hospital costing close to $70,000, it’s easy to see why.

What is the time limit?

Most health insurance providers have a 365-day limit from the date of your medical service until they stop accepting claims for that service. Some companies and some policies may only allow 180 days or even 90 days. When your insurance company says the deadline for filing has passed, it means they are no longer required to pay your claim because it was filed outside of your policy’s time limit. 

Take action

It’s now your responsibility to determine what went wrong. Did the hospital have your insurance information? Did the staff file it correctly? Was their claim missing important information? The best place to start your fact-finding mission is with the insurance company. Call and ask for specifics on the claim(s) related to your hospital stay it received. Get dates and names: When did they receive the claim, when did they ask for additional information and whom did they talk to?

If the mistake rests with the hospital or medical provider’s billing department, it is their responsibility to get it corrected. Armed with the information from your insurance company, you can call the hospital to discuss what went wrong and what can be done to remedy it.

In certain cases, you could be on the hook for the bill. If the hospital was not in your insurance company’s network of providers, it generally won’t cover your stay. If you provided inaccurate information that held up the claim, you could also be responsible. But if there were simple errors in the dates of service or other things beyond your control, the insurance company may reconsider your claim. 

Perhaps the most important bit of advice when dealing with a significant bill like this is to act promptly. Don’t put off calling your insurance company and the hospital to try and remedy the bill. If you run into brick walls or aren’t getting anywhere in resolving the bill despite your best efforts, it may be worthwhile to speak with a medical bill advocate about your situation. These professionals are experienced in spotting and remedying medical bill errors and even in negotiating lower balances.

Have your own question? Get answers here.