Is a doctor required to file insurance claims with an out of state insurer if they accept it at time of service?

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Is a doctor required to file insurance claims with an out of state insurer if they accept it at time of service?

I took my son to the emergency room at the hospital which stated they would bill out of state insurance company. The doctor that saw him at the time is now refusing to bill the out of state insurer even though at time of service they took all the information and never once stated they would not accept it. My younger son was seen by a doctor in the same group a couple of months earlier and they billed the insurance and the bill was paid. What is the doctors obligation in this?

Asked on October 13, 2011 under Insurance Law, Mississippi

Answers:

M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

You said at first "emergency room" which insinuates a hospital then you used "doctor" as if it is a private clinic.  Your health insurance policy has - I am sure - a provision fr coverage for out of sate visits in the event of an emergency.  This is also evident from your statement that your other son was "covered" in a visit to the same medical group out of state.  The hospital has the obligation to bill your insurance company first and then you if they do not pay.  If I were you I would report the emergency visits to your insurance company asap and send them a copy of the bill.  Have a representative get in touch with the hospital billing department.  See what happens.  Write back if the matter does not resolve itself.  Good luck.


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