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?

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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 6 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.


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