I completed treatment with my mental health care provider last March
2001. I was notified in April 2002 by my insurance company that it
would not pay the claim filed by the treatment center because it was
filed a year after the fact. Now the mental health center wants me to
pay this bill.  (Actually I haven't received the bill yet.I was told
this over the phone by their customer service rep.)  The treatment
center did not let me know until April 2002 that it lost my health
insurance information. Isn't the mental health care provider(which was
on my insurer's preferred list) obligated to file in a timely manner? 
Shouldn't they have let me know if they had problems with my
insurance?  Shouldn't they have sent me a bill in time for me to file?
The big question is: Am I legally responsible for this bill?

That's a lot of questions and I can see your frustration with this,
I've been through a very similar problem. First of all, as far as I
know there are no real lawyers here in the Google-Answers, and you
will want to talk with one before this is over. I'm not qualified to
give you legal advice.

As to the big question, Yes, you are legally responsible for the bill.
That is a given. As to who is going to pay for it, or not get paid, it
may go to the point of a court decision for that.

There are two factors at work here and getting your documentation now
is going to save you time and hassle latter. First, the insurance
company is suggesting that a year is too long for a claim to be filed.
That should be written somewhere in your policy. Ask them where it is,
and ask them for a copy of that policy with your signature on it,
showing that you agreed to this policy.

Second factor is the hospital. A year is a large amount of time to
send it an invoice for payment. I would call them directly and ask for
a written explanation sent to you explaining why it took a year for
them to file an invoice with your insurance company.

In both cases, write down the date, the time and who you were talking
to. That is important. Keep notes. Keep them safe. I can't stress that
enough.

No matter what they respond, you have done your foot work. There
aren't going to be many "hard fast" rules here, you are dealing with
"company policy" and procedure.

After you have used the phone for the above questions, put the same
questions on paper and send them to the person you talked to on the
phone.

If the answer you got from either party suggested that they are going
to send you information, wait a few days for that to show up. If it
does, great, if not, that's okay too. You've done your part.

Now, contact a lawyer, and show her your notes, and tell her your
story. Her first action will probably be to do the exact same thing,
call each party and write them a letter. She'll have the contact names
you gave here, and from experience, 75% of these things are solved
right there.

The burden is on you. It is your bill and your agreement to pay that
bill that puts you in this position. Its not a bad position unless you
don't do your foot work and solve it in a timely manner. Whether it is
fair or unfair is not the point.

Links for further information :

http://consumerlawpage.com/article/insure.shtml

http://caag.state.ca.us/publications/womansrights/ch2.htm



I hope this helps you and if you need any clarification please don't
hesitate to ask.

webadept-ga

Good Day, jane8849-ga.

Do not despair!

Most states have a "prompt payment law" which should protect you.

An example is the New York prompt payment law: 
"Prompt Payment Law
In summary, the Prompt Payment law, effective January 22, 1998: 
Sets standards for the prompt, fair and equitable settlements of both
patient claims and provider services;"

 http://www.ins.state.ny.us/hppmtlaw.htm

In the same situation, I would call the appropriate Department for
Insurance in your state.  Discuss your problem with them.  Ask about
the prompt payment laws of that state, or give us the name of your
state.  One of our Google researchers should be able to find your
states' laws on prompt payment.
I did notice that the prompt payment laws in Texas and Georgia levied
heavy fines on insurers that did not pay timely.

Best,
Brad-ga

I don't believe the prompt payment law applies here, since it is not
the Insurance company that is a year late.

webadept-ga

Hi Jane 8849.

Not to fret ... not yet.  I had the exact same situation and one
simple letter cured it.

Let me say that letters are more powerful on attorney letterhead so if
you can get a lawyer just to write a letter, you'll be in good shape. 
However, if you do not want to get an attorney yet and are writing
this letter yourself, I would begin by saying that you were going to
retain an attorney but opted to try and resolve it yourself.  Address
the letter to your health insurance and (a) advise them of all the
pertinent dates [when you began/ended treatment, when you gave the
provider your insurance information, when you first learned they never
submitted the bill...], (b) placing the blame on the provider for not
submitting the bill in a timely fashion and that you should not be
penalized for their error, and then (c) ask the health insurance
company to reconsider their denial.  Copy the provider on it so that
they know exactly where it stands.  I was dealing with Blue Cross/Blue
Shield, and they did reconsider and pay the claim after that one
letter.

If the insurance company still won't pay the claim, I would then write
to the provider with a copy of the health insurance company's response
maintaining their denial of the claim and ask the provider to write
off that portion that would have been the health insurance company's
responsibility to pay if the bill was submitted in a timely fashion. 
Also include that you would be more than happy to pay your
responsibility but only after they provide proof that they have
written off the portion that is not your obligation.  Hopefully that
would be the end of it.

Their remedy would be to sue you for payment and then you will have
these letters documenting the circumstances, which would work very
well in your defense for not paying the bill.  Chances are they would
prefer not to pursue a court action for payment due to the time and
cost involved.  But if they do, you would be ready with your
paperwork!!

Good luck!!

-Tracker-