by Bruce Pitkin
(Hilton Head Island, SC, USA)
I have requested an itemization for a Dr’s Visit made in October 2011 for which we received our first statement in June of 2012. The facility is part of a Hospital. They indicate one was sent initially and there was a delay in billing. But we never got it and they said they can’t send another one.
Is there any billing practice or regulation covering medical billing.???
Thank you in advance for your assistance.
Sounds like they just dropped the ball in sending you a statement. I’ve seen a lot of situations where the billing was such a mess they hardly ever sent out patient statements – or they were sent out a year or more after the visit. Sometimes there are delays in filing the claims that aren’t resolved for several months before the patient statements are sent.
Unfortunately to my knowledge there’s no Patient Bill of Rights that includes limitations on how long a provider can wait. There is a Patient Bill of Rights provision to the 2010 Affordable Care Act, but it doesn’t address billing issues like this.
Some states may have patient rights laws. You may want to check with your state’s insurance commission or simply Google your state name followed by “patient rights”. Most states have a statute of limitations on collecting a debt, but they vary by state and are usually a minimum of three years.
Sometimes your biggest ally in this is your insurance company. Insurance companies have what are called “Timely Filing” limits. This means that the provider must submit a claim by the Timely Filing deadline to be paid for the visit. This can be anywhere from 90 days to 2 years. Make sure your doctor isn’t billing you for the visit because they didn’t file the claim in time.
You are right in asking for an itemized copy of your bill. Before you begin disputing it I would also look at your insurance EOB (Explanation of Benefits) or claim(s) filed for this visit. You can usually access via web or call them and they can send it to you. Sometimes a provider or hospital bill doesn’t reflect the insurance contracted amounts. Or they don’t reflect the contracted or allowed amount on the statement. Having the EOB can help a lot when dealing with the provider. If the EOB and statement are in agreement then there’s not much you can do if it’s within the statute of limitations for your state. Also make sure any co-pays, coinsurance, deductibles, etc. are correct.
Hopefully you haven’t gotten to this point yet but If they turn you over to collections, ask them to verify the debt. There’s a good discussion on this at the Credit Info Center at http://www.creditinfocenter.com/rebuild/debt_validation.shtml (sorry I can’t hyper link to it because I’m told it violates Google’s Webmaster guidelines – how I don’t know).
Also don’t hesitate to try to negotiate the patient portion – especially for something your insurance doesn’t cover.
Hope this answers your question – or provides you with some info to help.