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My husband went into cardiac failure while we were traveling. He was taken by ambulance to the nearest hospital ER. I gave his insurance information at the time of service.

About a month later, I received a phone call from the billing department requesting more information. I complied, giving them what they asked for along with copies of our Medicare Advantage insurance card.

Months later, the billing office called again for the same information. I told them I have given this to them twice, why are they asking for it again? They apologized and said that someone must have misplaced or lost the information. So I gave it again.

Two years later, I received a bill for $3,625.00 . They said I failed to respond to their attempts to collect the balance due. They asked me to pay it in full no later than 10 days or be sent to collection. I noticed the insurance information on the statement. It also showed that the insurance was never billed and they were billing me for the full amount.

I then called the billing office and asked why our insurance was never billed. She had no answer and said that she would send it back to billing and find out what happened. She told me to call back in three weeks. Here we go again.

It has been a little over two years. Everything in our lives has changed since then and we no longer have this coverage. We are disabled seniors living only on social security. We have very little to live on. The hospital accepted our insurance at the time of service. If the insurance was billed in the beginning, this would have been paid in full. Is the insurance going to pay this charge? Will we have to pay this bill?

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    This is so stressful that my words won't mean much, but you need to escalate this at the hospital, and possibly find a pro bono lawyer through Senior advocates in your area. Barring that, if they send it to collections, think about suing them in small claims court. – RonJohn Jun 17 at 8:16
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    This probably isn't helpful but I've received initial bills from medical providers in with red stripes on the envelopes saying "FINAL NOTICE" and the bill will say the same and some threat to be sent to collections when the date of service was a week prior. These billing offices aren't efficient and I think some only have paper with FINAL NOTICE printed on it. – quid Jun 17 at 17:40
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    What's probably going on is someone dropped the ball and the insurance isn't going to pay it because it's way too late. In network providers are required to write off the bill if they mess up like that--but that doesn't mean they won't try to get money out of you anyway. Debt collection is a very dishonest business. – Loren Pechtel Jun 17 at 23:45
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    @LorenPechtel is absolutely correct. You probably will not have to pay this bill. If even a portion of it was to be covered by insurance it is the provider's responsibility to submit it in time. If they missed the cutoff they will end up eating the cost. The key is to not pay it, not agree to pay it, but also to not ignore it. Every time they send you a bill that has not been sent to insurance, call them and demand that they first submit it to the insurance you had at the time. This is your right as you had insurance at the time. Since they will not be able to eventually it will be dropped. – Justin Ohms Jun 19 at 7:13
  • @LorenPechtel But what ER in the country is in any network??? – Michael Jun 20 at 0:12
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Waiting two years is weird. However it's possible that this whole thing got a 15-month "pause" because of the pandemic, and that would make the timing more plausible.

Regardless, do not let this stress you out. It's just a normal and common billing snafu.

Contact your (old) insurance company

The old company will cover the claim because the event was during the time of their coverage.

Generally, insurance companies will mail you reports and statements. They will describe the services you got, the "insurance company rate" the hospital charges for that service, what fraction of that service is picked up by the insurance, and what fraction is your "co-pay" or otherwise your responsibility.

In other words, the insurance company will tell you when and how much to pay the doctor.

It sounds like the hospital botched their billing. It happens all the time - one went in circles because they copied only one side of my insurance card, meaning the only number on it was for the wrong department.

You should submit all the info you have to your insurance company. Most likely they will reach out to the doctor's billing office and either settle the account for you if it's their pay-in-full, or get the bill into their system so that the proper price is charged and so you split the bill properly with the insurer.

The only thing is, you need to stay in front of this and not let it "slip through the cracks" again. It's annoying that keeping your money should have to be work, but that's how life goes with private insurance.

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    The insurance company's going to say "too late". – Joshua Jun 17 at 20:48
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    We pay claims that are more than two years old all the time. I doubt we would try to track it down in a situation like this though ("they will reach out to the doctor"). – Hannover Fist Jun 17 at 20:55
  • @HannoverFist: even when the coverage has lapsed in the meantime? – Martin Argerami Jun 18 at 4:46
  • Does this answer take into account that the insurance plan was already terminated ("we no longer have this coverage")? – nanoman Jun 18 at 5:04
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    @MartinArgerami Yes. Lapsing coverage doesn't void every pre-existing claim. – Harper - Reinstate Monica Jun 18 at 5:45
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In addition to Harper's answer, if the insurance company also gives you the runaround, here are some reasonable next steps:

  • Write down everything. Focus on the facts; don't editorialize or write your opinions, just put down what actually happened. Keep any written documents which can corroborate your story.
  • Keep talking to both the hospital and the insurance company. Do not acknowledge the validity of the debt. Do not agree to pay anything. Just keep telling them that they should work it out between them, and it should not be your problem.
  • The insurance company may want you to pay for the current year's deductible. This is probably not correct, because the cost was accrued in a previous year, whose deductible you presumably already paid. They may also ask you for coinsurance or other costs; you will need to consult your policy to determine whether this is valid.
  • If the hospital doesn't just hand the debt off to the insurance company altogether, they will almost certainly try to haggle with you. In general, the "sticker price" in American healthcare is a made-up number that nobody actually pays (except people who don't know any better). They will bring the price down until they think you are able to pay.
  • It's possible that the insurance company will decide (or has already decided, but neglected to inform you) that some portion of the bill was "out of network" or otherwise not covered. Unfortunately, there's not a whole lot you can do about that, if they are correct in their assessment. But they might be wrong about that, so be sure to dig into all of the details and verify that they got it right.
  • Consider talking to a lawyer, if it looks like you're going to end up in court.
  • Familiarize yourself with the Fair Credit Reporting Act and the Fair Debt Collection Practices Act. If your bill gets sent to collections, you are going to need to know the ins and outs of those laws in order to protect your rights. Here are some of the more pertinent bits:
    • Debt collectors are not supposed to contact your employer, and you can demand that they conduct all business in writing. They are also not supposed to lie to you, intimidate you, or use other coercive or unethical means to get you to pay. Ultimately, you can force them to either file a lawsuit or stop contacting you. If the debt is of dubious validity, many will choose to stop contacting you as the lawsuit is unlikely to be worth it to them. However, they will sometimes turn around and resell the debt to another collector, so you might have to start the whole song and dance over again.
    • You can, and should, monitor all three credit reports (at http://annualcreditreport.com, not at any other site that claims to offer a "free" credit report) and complain if you see any debt which you do not recognize as valid. Whoever provided that information is required to either verify or remove it within 30 days.
    • If the laws are violated, and you can prove it, then you can complain to various people depending on the specifics, but the FTC and the CFPB are probably good starting points in most cases.
  • Do not pay any portion of the debt unless you are satisfied that you genuinely owe the whole debt. If you make any payment towards the debt, no matter how small, it may reset the clock on the statute of limitations, and they may also try to use it as evidence that the whole debt is valid. But if you have a written agreement to fully pay off the debt for less than the full amount, then that is probably binding.
    • You can try sending them a check that says "complete and final settlement" on the memo line, made out for the amount that you think you owe. Depending on the circumstances and applicable law (out of scope here), the rest of the debt may or may not be legally extinguished if a creditor cashes that check. Ask a separate question if you really want to try this trick, because the law is rather complicated.
    • Supposedly, some creditors will offer a "pay for removal" deal, where you basically pay them to fix your credit report and go away. The credit reporting agencies do not consider this a legitimate service; if the creditor takes the money and runs, you're probably going to have a hard time getting them to uphold their end of the bargain.
  • Once the statute of limitations has run (length varies by state), debt collectors may still try to contact you. Tell them the debt is invalid and refuse to discuss it with them.
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    Does this answer take into account that the insurance plan was already terminated ("we no longer have this coverage")? – nanoman Jun 18 at 5:04
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    @nanoman: The insurance company is responsible for all claims (that fall within the policy) that arise during the coverage period, regardless of whether the policy is still in force today. If OP was covered at the time the expense was incurred, then the insurance company should be responsible for it, assuming it was in-network etc. Of course, the statute of limitations may make the debt invalid altogether, but that is (or should be!) between the hospital and the insurance company; OP should not be getting caught in the middle like this. – Kevin Jun 18 at 7:19
  • @Kevin I agree -- I just thought that, e.g., "The insurance company may want you to pay for the current year's deductible" sounded odd. What is the deductible on a nonexistent policy? – nanoman Jun 18 at 8:00
  • @nanoman: Kevin is warning about incompetence and habit, and possibly underhanded behavior. The fact that there isn’t coverage at the moment neither causes nor removes any of them. – jmoreno Jun 18 at 11:29
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    @WaterMolecule Because we've been bamboozled so thoroughly that you're asking the wrong question entirely. We have a garbage health insurance system, but health insurance is not health care. (It's not even insurance, really, not as we normally think of the term at least!) But for decades now, and particularly since the Obama administration, insurers and their lackeys in politics have been conditioning people to conflate health coverage with health care. There are proven strategies to make health care more affordable, but they have nothing to do with making insurance more affordable. – Mason Wheeler Jun 19 at 11:18

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