If a doctor’s office submitted claims late and were denied by my insurer, am I responsible for their mistake?

UPDATED: Sep 17, 2011

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If a doctor’s office submitted claims late and were denied by my insurer, am I responsible for their mistake?

My doctor’s office failed to submit 2 claims on time to my previous insurance company; claims were submitted past the 90 day period. Now they have sent me a bill requesting payment of $1000 for services that would have been covered had they submitted on time. Am I responsible to pay this? Is there any evidence I can provide that will help fight this?

Asked on September 17, 2011 under Bankruptcy Law, Oregon


MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 11 years ago | Contributor

You are generally responsible to ensure your medical bills are covered but here your issue is not having insurance but actually a couple of things. First, your medical provider should have submitted the claim in time. Talk to your medical provider and explain they are responsible for taking care of this with the insurance company and inform the insurance company you will have a claim against them and file a complaint with your state insurance agency if they do not show good faith and cover you. Explain it is not your fault your medical provider failed to provide the claim in a timely fashion. You could not have provided the claim and therefore explain to the insurance company that you are not to be held responsible and this is a matter that it must resolve with your medical provider. Call the medical board and file a claim against those doctors, as well and your attorney general for the business itself. Essentially, call and write to as many government agencies as possible to help you in this endeavor.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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