Somehow a person fell through the cracks and we missed filing her insurance claims.
Total Comments: 3
Posted: Wed Aug 25, 2010 07:34 am Post Subject:
Well, I guess we're missing out on some information over here. Have you met with lawsuit regarding this? How long ago this mishap occur?
Posted: Wed Aug 25, 2010 11:07 am Post Subject:
Did the patient sign a document making you their agent for the purpose of filing a claim with their insurance company (a standard practice in most medical/chiropractic offices)?
Here's the bad news if that's true. Standard insurance claims laws generally require a person to notify their insurance company of a "loss" (covered claim) within 20 days. The insurer has 15 days to provide a response or deliver a claim form, then the insured usually has 90 days from the date of loss (treatment) to submit the proof of loss (provider billing) to the insurer for payment. In most states, one year is the absolute maximum a person might be allowed to submit their proof of loss.
If the insured's policy limits submission of proof of loss to the required 90 days, and more than 90 days has elapsed without the proof of loss being submitted, then the claim is forfeited. If you are the insured's "agent" in the claims process, and the failure is yours, then the insured cannot be held liable for the payment you did not receive due to your failure to present the proof of loss on a timely basis. Your efforts to treat the patient will be "pro bono".
If you've caught the error within 90 days, you'll be fine, if more than one year, you are entirely out of luck. Between 90-365 days, it's the insurance company's call.
Posted: Fri Sep 10, 2010 12:55 pm Post Subject:
How will the insurer judge it, if it's between 90-365 days? Does this call vary from one state to another?
Posted: Wed Aug 25, 2010 07:34 am Post Subject:
Well, I guess we're missing out on some information over here. Have you met with lawsuit regarding this? How long ago this mishap occur?
Posted: Wed Aug 25, 2010 11:07 am Post Subject:
Did the patient sign a document making you their agent for the purpose of filing a claim with their insurance company (a standard practice in most medical/chiropractic offices)?
Here's the bad news if that's true. Standard insurance claims laws generally require a person to notify their insurance company of a "loss" (covered claim) within 20 days. The insurer has 15 days to provide a response or deliver a claim form, then the insured usually has 90 days from the date of loss (treatment) to submit the proof of loss (provider billing) to the insurer for payment. In most states, one year is the absolute maximum a person might be allowed to submit their proof of loss.
If the insured's policy limits submission of proof of loss to the required 90 days, and more than 90 days has elapsed without the proof of loss being submitted, then the claim is forfeited. If you are the insured's "agent" in the claims process, and the failure is yours, then the insured cannot be held liable for the payment you did not receive due to your failure to present the proof of loss on a timely basis. Your efforts to treat the patient will be "pro bono".
If you've caught the error within 90 days, you'll be fine, if more than one year, you are entirely out of luck. Between 90-365 days, it's the insurance company's call.
Posted: Fri Sep 10, 2010 12:55 pm Post Subject:
How will the insurer judge it, if it's between 90-365 days? Does this call vary from one state to another?
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