Ehical question re: bill payment, what would you do?

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Celeste88

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I had a minor hospital procedure 8 months ago and wondered why I never got a bill from the surgeon. I had this procedure done before and ended up owing several hundred dollars a fews years ago as the doctor is not in my insurance network I have to pay 30% of the usual and customary charges plus a hefty deductable. Well, I was curious so I called the insurance company and the doctor NEVER submitted the bill to the insurance company. Perhaps the bookkepper forgot or what but their bill is unpaid and I’m struggling with the question of should I call them and remind them to submit it!? To make matters worse, the insurance company spokesperson told me if they submit it now it the claim would be rejected since their policy is 120 days for non hospital claims (dr. claims are considered non hospital)- late claims are rejected past the 120 days. This means that the doctor if nasty enough can come after me for the WHOLE bill! eeeek.:eek: What would you folks do?
 
Well you might take it as a blessing from God.

I once got in a fight between my doctor and the blood test company and the insurance company. In the end even though i tried to explain to the doctors office that i did owe the $50 and they should just keep the refund since they will get a new bill. They argued with me and sent me the refund. It’s been 2 years and i have never heard another peep from them about the bill so I take it as a blessing!

Also it is the doctors office fault. THey should have caught the mistake in their billing. If they do come after you you shouldn’t have to pay the full price anyways but only your normal coverage part since it was their fault for not submitting the correct paper work or contacting you in the first place.In most buisnesses there are policies for payment and if you don’t fall them then you are SOL.
 
You’ve contacted the insurance co., curious about why you haven’t been billed for your obligation.

I’d tell the Doctor’s office to pound salt. Upon arrival to their office I’m reasonably sure they didn’t even let you through the door without “Insurance information & Co-payment method please”…

If they don’t bill for their services it is their problem, not yours.

If they come after you about it I’d offer the same payment as before, in 90 or so days, or take me to court.
 
Celeste,

I have been biliing for physicians for 20+ years. You should call the office and have them resubmit the claim with proof of timely filing. I am sure the office did submit the claim, but you would be surprised at how many claims “get lost”-even claims submitted electronically. In the event the claim is still denied after the office submits with proof of timely filing, if your doctor is an in-network provider for your insurance company, he cannot bill you for any portion of the denied claim. He must write off the entire balance, per his contract with your insurance company. He cannot even bill you for what you would have been responsible for.

Good luck!
 
The doctor’s office made a mistake which you are not responsible for and it would be unfair for them to hold you responsible for the entire payment when you had insurance which you also pay for. Now the bad news. You are still morally and legally responsible for the portion of the bill which you would have had to pay anyway. Contact the doctors office and explain the situation to them as you have here. You did receive a service and it is only right to pay for it. It will empty your pocket somewhat but it will make you feel better knowing that you did the right thing.
God Bless.
 
tamie said:
Celeste,

I have been biliing for physicians for 20+ years. You should call the office and have them resubmit the claim with proof of timely filing. I am sure the office did submit the claim, but you would be surprised at how many claims “get lost”-even claims submitted electronically. In the event the claim is still denied after the office submits with proof of timely filing, if your doctor is an in-network provider for your insurance company, he cannot bill you for any portion of the denied claim. He must write off the entire balance, per his contract with your insurance company. He cannot even bill you for what you would have been responsible for.

Good luck!
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Tami is exactly right. I’ve had the same thing happen and it all went just as she said.
 
Interesting. Please explain how they cannot hold you to any part of the bill. I’ve never heard that before. Is that nation wide or part of a state law?
 
tamie said:
Celeste,

I have been biliing for physicians for 20+ years. You should call the office and have them resubmit the claim with proof of timely filing. I am sure the office did submit the claim, but you would be surprised at how many claims “get lost”-even claims submitted electronically. In the event the claim is still denied after the office submits with proof of timely filing, if your doctor is an in-network provider for your insurance company, he cannot bill you for any portion of the denied claim. He must write off the entire balance, per his contract with your insurance company. He cannot even bill you for what you would have been responsible for.

Good luck!
Click to expand...
Tamie, Unfortunately this doctor is out of the insurance’s network.If the entire claim is denied due to late filing can he come after me for the money?? :confused:
 
I don’t know, but I get the feeling if no one has contacted you by now this is just going to end up in mysterious land of “lost medical bill land.”

If it over a few hundred dollars, they might not even try to deal with collecting it, and just write it off, I figure thinking it’ll be less work in these situations when it’s questionable if the people even have the money, especially with the screw up that happend. The only big bills that got sent to collections where from places where I got regular statements.

If you’ve gotten no statements and haven’t heard anything in a few months, and you want to make it right ethically, you might just want to send some money a bit at a time to charity, and maybe specifically for medical care for the needy. So much stuff gets written-off, atleast you can send some to a fund that helps aid in those write-offs.
 
What a great Idea! That sounds just like a penance I got, a while back.

As other’s have written, it’s probably written-off. If the OP wanted to see if it affected her credit rating, she could pull a credit report. But as you brilliantly mentioned, some time/money sent to charity could ease any guilt the OP may feel and do good for others.
 
it’s not your responsibility to do you doctor’s record-keeping for him. Let it go and I like the idea of donating the same amount to charity.
 
Celeste88 said:
I had a minor hospital procedure 8 months ago and wondered why I never got a bill from the surgeon. I had this procedure done before and ended up owing several hundred dollars a fews years ago as the doctor is not in my insurance network I have to pay 30% of the usual and customary charges plus a hefty deductable. Well, I was curious so I called the insurance company and the doctor NEVER submitted the bill to the insurance company. Perhaps the bookkepper forgot or what but their bill is unpaid and I’m struggling with the question of should I call them and remind them to submit it!? ?
Click to expand...
technically it is the insured’s responsibility to submit bills to their insurance company. Most doctors and hospitals do this as a courtesy, but the insured must follow up and make sure it is done. Work with your insurance co. perhaps HRD dept. of company where you work can help you negotiate waiving the 120 day rule. If you paid any part of the deductible for instance at the time of service, that may mean you acknowledged and de facto submitted a claim for the service. Try to get hold of a supervisor.
 
It may still come. You are not sinning while you are waiting for the bill.

It would only be sinful if you deliberately tried to avoid paying it. If he has not presented you with it, then you are not culpable if you were and still are prepared to pay for it.

If you do not hear, I would say that if you are comfortably off financially then offer to pay it. If you are not, then continue to wait for the bill.then you may wish to make a small donation to your favorite charity and thank God for His goodness.

Good luck and God bless you
 
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