Doctor sending me a bill on PI case after 4 years

[LillianX]

I don't believe she can win a suit against you for it no matter what. The state of limitations for most kinds of debt in Maryland is 3 years.

If, when all is said and done, you discover that you do legitimately owe her the money, you should pay it. That said, the time for her to sue is long past. If she files a suit, simply point out to the court that the statute of limitations is three years.

 

[lealea1005]

She actually stated last time that she billed my insurance company for some visits and she did not for some visits. Since she cannot go back to the insurance company since my insurance company won't accept the claim that old she wants me to pay for it.

I did try contacting the insurance company yesterday and they stated that I'd be responsible if the provider did not bill the insurance company and that I should have been proactive and looked at the claim and made sure that the claims were submitted.

Oh no, they can't. In Maryland, if your provider is contracted with your insurance company and does not file a claim within that insurance company's timely filing period, the provider CANNOT try to collect from you.

 

[aldaron]

LeaLea knows her stuff, pray to the leaLea priestess.

 

[aldaron]

That was meant as a compliment.

 

[graci]

Oh no, they can't. In Maryland, if your provider is contracted with your insurance company and does not file a claim within that insurance company's timely filing period, the provider CANNOT try to collect from you.

How do I verify this? I already called united healthcare (my insurance) and they said that I should have looked at all the claims and made sure.

Do I have a case that she billed me on a date when I was not even in town???

 

[ecmst12]

I bet your insurance company will be VERY interested if you send them proof of the fraud.

 

[graci]

I bet your insurance company will be VERY interested if you send them proof of the fraud.

I am not even sure if they'd care about a claim that old...I think I would only bring it up if this information would help me in any way.

 

[ecmst12]

Insurance companies take fraud very seriously. Even if it's too late for them to prosecute, I am almost certain they can still take back their payment.

 

[aldaron]

Emcst i've been through this and it was about 4 years if i remember correctly. They had a valid claim under tx law, I had to prove I didnt owe it by records. Valid under assertion and services provided they claimed.

 

[graci]

That one claim was only $210 and my insurance paid like $60 for it...so even if I can prove that it is fraudulent the provider can easily pay back $60...I think provider wouldn't mind paying back $60 against $3400.
My point is that unless I can prove that she is fraudulent and other charges are either invalid or her negligence to send bill to my insurance it is pointless to tell the insurance about the $60 charge.

 

[ecmst12]

The amount is almost irrelevent, the fact that she engaged in fraudulent billing ONCE means it is nearly certain she did it other times. The insurance company will go through all her claims with a fine toothed comb and audit every penny, turn her office upside down, demand records for EVERYTHING, make her life miserable, and very likely terminate her contract because of it.

If you want to be kind, mention in your letter that if she does not cease sending you these false bills, you will be glad to turn over to your insurance company your proof that she has been engaging in fraud. I bet you never hear from her again. Then send the info to your insurance company anyway, because crap like that hurts everyone.

 

[graci]

I am not sure if I should reveal this information to her yet...so she doesn't get time to be prepared just in case...
Would you think it would be better to try out other things like statute limitations and her negligence to submit paperwork to insurance??

The amount is almost irrelevent, the fact that she engaged in fraudulent billing ONCE means it is nearly certain she did it other times. The insurance company will go through all her claims with a fine toothed comb and audit every penny, turn her office upside down, demand records for EVERYTHING, make her life miserable, and very likely terminate her contract because of it.

If you want to be kind, mention in your letter that if she does not cease sending you these false bills, you will be glad to turn over to your insurance company your proof that she has been engaging in fraud. I bet you never hear from her again. Then send the info to your insurance company anyway, because crap like that hurts everyone.

 

[lealea1005]

I am not sure if I should reveal this information to her yet...so she doesn't get time to be prepared just in case...
Would you think it would be better to try out other things like statute limitations and her negligence to submit paperwork to insurance??

Maryland providers contracted with United Healthcare are specifically prohibited from attempting to collect from the patient when the claim is submitted after the timely filing period. If UHC finds that the provider continuously attempts to collect, they will probably lose their contract with UHC.

I think ecmst's advice to include the fact that you are prepared to turn the claims over to UHC for review is excellent. Fraud is a VERY big deal with insurance companies.

 

[graci]

Thanks a lot for your inputs. That really helps.
Can I send it in writing that I have at least one proof that she fraudulently billed my insurance company when I was away??? I have typed up a draft letter to her (I have not included yet that she billed my insurance incorrectly) but it states:
1. I have contacted ins. co. and there is no unpaid balance.
2. United states that in network should submit claims within 90 days and patient or insurance company is not responsible after that
3. Please provide me with documents such as EOBs, itemized bills, dates of services for all visits.

I was actually out of country for that one visit that she has charged united. I am not sure how to present this.

Thanks again.

 

[graci]

Maryland providers contracted with United Healthcare are specifically prohibited from attempting to collect from the patient when the claim is submitted after the timely filing period. If UHC finds that the provider continuously attempts to collect, they will probably lose their contract with UHC.
I think ecmst's advice to include the fact that you are prepared to turn the claims over to UHC for review is excellent. Fraud is a VERY big deal with insurance companies.

I am not sure why united rep told me that I should have been looking at all the claims and should have reported if there was any visit that was not claimed. I talked to the resolutions team at united last time...I am not sure who I should talk to now about this.