What to do if our pediatrician took our insurance but due to a clerical error didn’t submit the bill to our insurer for 6 months so now the claim is being denied?
Get Legal Help Today
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
What to do if our pediatrician took our insurance but due to a clerical error didn’t submit the bill to our insurer for 6 months so now the claim is being denied?
The insurance company refused to pay it because it was past their acceptence window. Now our doctor is billing us the full amount. We feel that we paid and completed our side. It’s their issue internally and should not be forced on the customer. What the law?
Asked on October 27, 2014 under Insurance Law, California
Answers:
MD, Member, California Bar / FreeAdvice Contributing Attorney
Answered 9 years ago | Contributor
It is not your issue. The insurance and the doctor's office both committed an error and bad faith. Inform the doctor's office you will refuse payment and report the medical office to the medical board and to the state attorney general. File a complaint against the insurance company with your state's department of insurance and with the insurance company itself. Explain this is not your issue. Inform the doctor's office it committed the error and cannot bill you for any additional funds due to their negligence.
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.