Five years ago, my daughter was born. A few months later, the OB-GYN contacted us, saying the insurance company hadn’t paid him.
My wife called the insurance company, and they told her the doctor’s office had used the wrong medical code on the bill. The rep said that code had already been paid out and that the doctor’s office shouldn’t be bothering us.
Now, nearly five years later, the doctor has sent the account to a collection agency. The agency is pretty shady they even tried to convince us that the insurance company had sent us a check.
I contacted the insurance company, and they pulled up the explanations of benefits from the birth: one from the hospital, which was paid, and two from the doctor. The first bill from the doctor was denied because they used the same medical code the hospital used. I don’t fully understand this since I’m not a medical biller. The second one, submitted two years later, was denied for being past the submission deadline.
Regardless of the length of time, the insurance company will undoubtedly attempt to reject everything you ask the doctor to resubmit. The typical insurance billing timeframe is six months to a year. Thus, be ready for that.
The first claim from the doctor was denied because they used a medical code that the hospital had already used.
What the insurance company is essentially saying is:
“The medical records show that the hospital provided the service, so we paid them using that CPT code.”
The second claim, submitted two years later, was denied because it was past the submission deadline.
That’s standard procedure. In-network doctors usually have a contractual obligation to submit their claims within a specific timeframe. If they miss it, it’s considered a write-off.
I recommend asking the insurance company to send you the Explanation of Benefits (EOB) statements for the claims in question.
As frustrating as it is, if your wife agrees, go to the hospital and request the childbirth records. Make sure they understand you also need the doctor’s progress notes, SOAP notes, simple notes, pre/post-op notes, phone notes, and discharge notes.
If the OB/GYN didn’t document it, it didn’t happen—and they can’t bill for it.
You’ll need to become somewhat knowledgeable about medical billing, insurance, and collections law if you want to fix this on your own. It’s not going to be easy, especially since it’s been five years.
It’s also time to familiarize yourself with the Fair Debt Collection Practices Act (FDCPA) and how it relates to medical debt collectors. You have the right to ask them to stop contacting you and to validate the debt.
Go back to the insurance company and speak with the claims department. Explain that an in-network doctor is trying to collect on a debt.
A) They submitted the claim using an incorrect or duplicate code (which was potentially billed by another provider—the hospital).
B) They waited until after the submission period expired to try to correct it.
C) When it was denied, they tried to balance bill you, the patient.
Ask what resources they can offer in dealing with the doctor’s violation of their contract, since the bill has now been sent to collections.
The majority of the responses provided here are incorrect. To register a complaint, go to the Washington State Department of Insurance. In addition, you must file a complaint about the doctor with the insurance department and with the insurance company. They need to have made the billing corrections on their own.
Contest the obligation and the agreements made between your physician and the insurance provider. It’s not your issue that they failed to follow up and failed to bill correctly. Provide a debt validation letter to them; if you are sued, respond with court documents and appear in person. When I appeared in court, they promptly dismissed the case against me.
Medical debt has a four-year statute of limitations in California.
CCP Section 337 for nearly all contracts: four years from the bill’s date. Take note of the §360 exception, which extends the SOL to the date of the last payment, and the “open book” exemption, which extends the SOL to the last service given. The law is the same whether the bill is from a county or state hospital; however, you must mention CCP § 345."
If your doctor was in network with your insurance, they usually couldn’t charge you more than what they would be willing to pay (apart from your copay). As members of the network, they consent to that. Not a balance billing. And most definitely not after several years. It must be fixed on their end, but you can send the collection agency a cease and desist letter stating that you will file for reimbursement under the Federal Debt Collection Act if they attempt to report it. You are past the statute of limitations, so they cannot file a lawsuit against you unless you reset the clock by paying something or saying something similar over the phone.
Throw it away. Prior to the seven years permitted, they are attempting to collect on past-due debits. He probably lacks any documentation proving your identity. Ask for evidence of the debit if you receive another one, and respond to it by pointing out that he neglected to provide the bill on time. Handle the doctor’s office rather than the debt collecting agency. These accounts are purchased by these collection agencies for a few Pennies each.