Urgent Care Emailed Me a Medical Bill 1-1/2 Year Later Informing me My Insurance Denied It and I am Now Fully Responsible. Can I Contest This?

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Here’s the part the urgent care conveniently did not tell you: – If they’re in network with a provider they have a requirement to accurately bill you within a certain window (like 180 days). If they do not, they agree with the insurer to eat the cost. Now, you probably separately signed an agreement to be responsible for all charges blah blah blah, and if you did give them the wrong insurance and they can prove it that might muddy thigs. But in the meantime: 1. Look into your insurance to see what the rule are around timely billing. 2. Ask them to resubmit the claim. 3. If and only if it fails to go through AND they continue to bill you, make sure they’re aware of their agreement and try to bring your insurance company in on your side (a 3 way conf call w/ the doctor, you and your insurance can go a long way). TL;DR They may be violating their agreement with your insurance by billing you too late, they could get in trouble w/ that insurance company b/c of it and generally they’ll leave you alone rather than mess with it.

dweezil22

Tell them to run the correct insurance for the time. The person who said she’s “sure” it would get denied sounds too lazy to try it.

AceyAceyAcey

Something I did not see mentioned, here. There was a case of a woman in billing in a hospital in Southern California, who sent out fraudulent bills of this nature. The bills demanded payment. She had racked up over $100,000 for herself by doing this exact thing. It took the hospital two years to catch her. The victims were all worried about their credit and thought their insurance had not paid. My brother paid. It took his insurance company and the hospital haggling for six months to help to return it to him, since the insurance had paid his bill, also. Check with your insurance and with the hospital. Speak to a supervisor in billing and not a billing clerk. Exhaust all avenues with your insurance before you do this. Know that the hospital may have to eat the costs if they did not bill you in six months or less.

RicottaPuffs

I actually work for an urgent care facility. Baptist. I’m not in collections but I have an understanding of the billing process. The contract at my facility is that we have to submit the claim within a certain period. After that we have so long to submit it late. After that, insurance will normally decline it saying its too late to send the bill even if you had coverage. So coverage =/= they pay for it. BUT here is the important part. If we do not submit it accurately to the right insurance, and we fail to get the bill resubmitted to the correct one before the deadline with our contracts or the insurance companies policy, the company submitting the claim, so urgent care, is responsible, because they failed to send the bill in time. So I would fight this if it were me.

Fayarager

I had this exact same thing happen. I had to go sit in the billing office and tell them I wasn’t leaving until they showed me proof that they billed insurance and that I wanted to see the denial from the insurance company. I let them know if they couldn’t provide me with this proof that they either needed to write it off or they could be talking with me in small claims court. They wrote it off.

seriouslyjan