A $4,000 medical bill received 58 months after the service raises several questions, concerns, and possible explanations. Understanding the circumstances surrounding this delayed billing can help shed light on why it took so long to receive and how to handle such a situation.
Medical billing procedures can vary between healthcare providers, insurance companies, and even geographical regions. These complexities can often result in delays in billing, particularly for non-urgent or non-emergency services. Let’s explore some potential reasons for the lengthy time gap between the medical service and the receipt of the bill.
1. Administrative Delays:
One possible explanation for the lengthy delay in receiving the medical bill is administrative issues within the healthcare provider’s system. In a busy hospital or medical office, it is not uncommon for invoices to get misplaced, forgotten, or take longer than expected to be generated and sent out. A change in billing systems, staff turnover, or miscommunication within the administrative department could all contribute to such delays.
2. Insurance Billing Discrepancies:
If you have health insurance, it’s essential to consider how your coverage might have played a role in the delayed billing. Insurance providers often negotiate rates and processes with healthcare providers, which can add complexity to the billing process. These negotiations can result in delays in the approval and payment of claims, ultimately affecting the timing of billing statements. Insurance companies might require additional documentation or verification, causing further delays in processing the claim.
3. Inadequate Patient Information:
Incomplete or inaccurate patient information can also delay the billing process considerably. If there were any errors or omissions in your personal details, insurance information, or contact information, the healthcare provider may have struggled to locate and bill you appropriately. It is crucial to ensure that your healthcare providers have your up-to-date contact and insurance information to avoid such scenarios.
4. Procedural Coding and Documentation:
Medical billing relies heavily on procedural coding, which assigns specific numerical codes to different services and treatments. These codes are then used to generate bills and process insurance claims. If there were any issues or errors in coding the services you received, it could have caused a delay in billing. Additionally, incomplete or inadequate documentation of your medical records can also lead to delays as the healthcare provider works on gathering the necessary details to generate an accurate bill.
5. Unforeseen Circumstances:
Sometimes, unforeseen circumstances can disrupt the medical billing process. For instance, if there was a dispute or investigation related to the healthcare provider’s services, it might have caused delays in billing. Such situations are relatively rare, but they can occur, potentially resulting in a lengthy gap between the medical service and the receipt of the bill.
Regardless of the cause, it is essential to take certain steps when faced with a delayed medical bill:
1. Contact the Healthcare Provider:
As soon as you receive the bill, it is recommended to contact the healthcare provider’s billing department. Inquire about the reason for the delay and ask for a detailed breakdown of the charges. If you have health insurance, verify if the claim was submitted and if any additional documentation or information is needed.
2. Investigate Insurance Coverage:
If you have health insurance, reach out to your insurer to ensure that they have received the claim and inquire about any discrepancies or issues they might be facing in processing it. Ask if there are any pending approvals or if the claim was denied for any reason.
3. Validate the Charges:
Review the itemized bill provided by the healthcare provider carefully. Ensure that you correctly received all the services listed and that the charges are accurate. Mistakes can happen, and it is essential to address any errors promptly.
4. Negotiate, if Necessary:
If you are uninsured or facing financial difficulties, consider discussing the bill with the healthcare provider’s billing department. In some cases, they may be willing to negotiate a reduced payment amount or offer a payment plan to help make the bill more manageable.
5. Be Aware of the Statute of Limitations:
While it depends on the jurisdiction, medical providers generally have a limited time window during which they can send out bills after rendering services. Research the statute of limitations for medical billing in your region to ensure that you are not being billed beyond the legally permissible period.
6. Seek Legal Assistance if Necessary:
If you encounter significant difficulties resolving the situation with the healthcare provider or believe that you are being unfairly charged, you might want to consult with a healthcare attorney who specializes in medical billing disputes. They can evaluate your case and provide guidance on how to proceed.
In conclusion, receiving a $4,000 medical bill 58 months after the service presents several possibilities and potential explanations. Understanding the intricacies of the medical billing process, possible administrative delays, insurance discrepancies, and other factors can help shed light on why such a lengthy delay occurred. By taking appropriate steps, communicating with the healthcare provider, verifying insurance coverage, and addressing any errors or concerns, you can navigate through the situation and resolve the billing issue effectively.
Write them back and deny the debt.
A few years ago, I got contacted by a medical service collector — the anesthesiologist wanted more through “balance billing”. They didn’t like the payment they got from the insurance company. They contacted me…oh I’ll say 18 months after service rendered. I called up the insurance company (my insurance provider had not changed), and they declined to review — saying it’d been too long. I called back the collector and said what the insurance company said. That ended up being the end of it. No credit report ding, no further bothering by the collector.
But that was I think an $800 bill, not a $4000 bill.
Contact the old insurance company. Explain. Ask them to review the bill. Then report back to the biller with what the insurance company old you.
Document everything. Date, time, name of phone rep at the insurance company.
Be careful searching on the internet. Unfortunately, the internet is bad at forgetting bad information…and law changes. My understanding is that the balance billing stupidity that hit me isn’t legal anymore.
Treat this like a problem between the service provider and insurance — unless you can find a EOB (explanation of benefits) that proves insurance told you that you would be responsible for 4k.
I received a $1,500 bill from the orthodontist nearly 800 days after the last time I stepped foot in their office. I was nervous at first, but I researched the laws in my state and realized that they were totally out of line sending me that. I had insurance at the time of treatment that covered that cost 100%. They did not file the insurance in a timely manner, and then did not contact me until long after I could have filed a claim with my insurance. Because they made a mistake and waited too long, they were not entitled to collect on that debt.
I wrote a letter that demonstrated my knowledge of the state laws, specifically said the words “I do not acknowledge this debt,” and told them what they would need to send me in order for me to reconsider. (That would be proof that they had sent the claim to my insurance, the insurance denied the claim, and that they sent me a bill within 30 days of treatment, which they didn’t have.) I also told them that if they pursued me or sent this debt to collections, I would report them to the state insurance commission for not following the laws.
I sent this letter certified mail. I never heard from them again.
You don’t owe this. They waited too long, they made a mistake, it is not your problem. You need to specifically tell them that you do not acknowledge the debt and that you will report them to your state insurance commission if they continue to contact you about it. Send the letter certified mail and you should be in the clear.
It’s balance billing and they shouldn’t be doing it. Call your insurer and ask for help. I had a hospital do this to me for $12,000. I spent months going back and forth with them. Finally I thought to call my insurer. I got a customer service rep for Blue Cross Blue Shield who said that they cannot do that while contracted with the insurance company. He asked if I had time to stay on the line while he called them and threatened to document that they were in breach of contract and send it up to the management level in his company. I stayed on the line while he ripped them a new one, and I never heard from them again.
Providers usually have 12 months to bill charges to either you or an insurer OR if they have and have been underpaid, your insurer will have a specific timeframe the provider has to follow up within as well. It’s usually also 12 months from the date of service. Call your old insurer and tell them you’re being balance billed for this and they will take you through any dispute process if there is one at this point. But most likely it’s well outside their timely filing limit and the provider should not be balance billing you at all, I wouldn’t pay a dime.
>~$4000 for services rendered that weren’t covered by my insurer.
Step 1 is to ask that payer why it didn’t pay this vendor.
>this bill that I just received… 4 years and 10 months after services were rendered
Step 2: [California CCP §337](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=CCP§ionNum=337).
Medical bills are not supposed to effect credit scores or go on your record anymore. Call your insurance company. The hospital is required to bill within a certain time frame. The insurance company will probably send them a letter telling them this and they will stop billing you. (Assuming you are in the US).
Fours years statute of limitations on medical debt in California, they can’t judicially collect.
The CFPB has proposed a rule that wouldn’t let medical debts appear on credit reports but that is not currently the rule.
I would do what others suggest, dispute the debt as not yours and see if they want to waste their time even responding to your dispute.
There are businesses that sell their services auditing medical providers billing records and trying to find unbilled/unpaid services that they then try to get a cut of by getting the medical provider to try to collect it. They are looking for easy money from people who just write a check out of some sense of moral duty. Don’t be that person and they are likely to go away.
The law is online; [link](https://www.dir.ca.gov/dwc/ebilling/StandardizePaperBilling_FAQs.html#:~:text=For%20services%20rendered%2C%20or%20inpatient,discharge%20for%20an%20inpatient%20bill)
For services rendered, or inpatient discharges, on or after January 1, 2017, there is a statutory requirement that medical bills be submitted within 12 months of the date of service, or within 12 months of the date of discharge for an inpatient bill. (California Labor Code section 4603.2.)
Effective January 1, 2018, California Labor Code section 4610 was revised to provide a shorter time for submitting specified bills. Effective January 1, 2018, bills for services that are exempt from prospective review under Labor Code section 4610, subdivision (b), must be submitted within 30 days of the date of service. (Labor Code section 4610, subdivision (d) (1).) However, for emergency services rendered in a general acute care hospital, the bill must be submitted within 180 days. (Labor Code section 4610, subdivision (d) (2).)
If it’s been over four years in CA since there has been any communication then the debt can basically be expunged.
This happened to me about two years after an ER visit for my daughter. About 2000 bucks they asked for. As it turns out six months after the visit, I got a letter from the hospital saying that someone has stolen her personal information as a result of the visit. So I use that as leverage and said wait a minute you want me to pay you $2000 for a visit were you allowed all of her personal information to be stolen? How about you Forgive this and I don’t sue you.
Thats 5 years wait two more and it’ll be forgiven entirely (in the us)
That’s some timely billing right there! (/s)
You might have to call your insurer (or whatever insurance you had at the time) and see if they even show a claim for those services. If insurance is also just now getting a bill, the healthcare provider should be SOL because I don’t think your insurance carrier is going to pay their portion either.
Billing that late is ludicrous.
Is it the doctor or an agency?
Since you’re in California, you can tackle the insurance side of this by contacting the Help Center at the California Department of Managed Health Care. They regulate health insurers in the state of California. They can review the benefits you had at the time of service and determine if your insurance should have covered it or not. If they should have covered it, they will contact the insurer to try to remedy the situation. Other commenters have given great suggestions for handling it from the hospital side of things, but I wanted to throw this option out there in case your insurer should have paid for the services.
“I disavow this debt due to failure to notify in a reasonable time limit. Due to almost 6 years having passed, this debt was not notified in any reasonable length of time from the date of service. This balance billing is not permitted by the legal contract with the insurance provider. Any further attempt to pursue the matter will considered harassment. The insurance provider has been notified of the violation of the billing agreement.”
^Email the hospital the above and cc the insurance company. Call it a day.
Just got a letter like that too, for $2k, for a surgery in 2020. A surgery they wouldn’t perform unless I paid my part upfront, so not sure how I owe more
This practice of balance billing is becoming more and more common since venture capital is buying out hospitals and providers. Venture capital is already unethical enough to reduce the level of medical care to criminally negligent levels in order to make money. When they buy assisted living facilities, they’ll have just one nurse for over 100 beds.
They’ll buy a medical service provider, split the building they owned off to another company and lease it back to them, and leverage debt against them to make money while using that “debt” as an excuse to underpay and mistreat staff. Once the profits drop off, they’ll run it into the ground until it closes and still make money off of it. Leaving a community in a medical desert. They’re a scourge upon society.
Sending threatening letters on illegitimate debt, while terrible to the consumer, is just the tip of the iceberg. Venture capital salivates over buying these providers, seeing them as easy ways to squeeze money for ongoing treatment, while having books of debt that can be mined for more money.
The time limitation on initial billing of a debt vs how long it’s legal to collect on a debt are different. And if you acknowledge and pay anything on the debt, the clock will restart on how long they can collect. These limitations are different from state to state. Dig through the local statutes and don’t pay or acknowledge that the debt is valid until you’ve exhausted all other options. Including calling your insurance from the time, the provider, the relevant medical board, your state congressional representative, etc.
Unpaid medical debt over $500 *will* affect your credit score.
You can still call your old insurer and have them deal with it even if they’re not your insurer any more.
Good luck.
Fairly certain this is against the law.
My buddy’s son got really sick., hospital bills over $200k…..about 2-3 years ago. He’s never gotten a bill and nothing on his credit report so YMMV. My wife got sick and rushed to er almost 5 years ago., we didn’t have health insurance at the time and we haven’t heard anything from them either….so…
I’m not a legal expert, but there are indeed statutes of limitations that apply to the collection of debts, including medical debts, in California. Generally, the statute of limitations refers to the amount of time a party has to take legal action regarding a particular matter.
As of my knowledge cutoff date in January 2022 (please verify this as laws can change), the statute of limitations for medical debt in California is as follows:
Written Contracts: For debts that are based on written contracts, including some medical debts, creditors generally have four years from the date the contract was broken to file a lawsuit.
Oral Contracts: If the debt is based on an oral contract, creditors generally have two years to file a lawsuit.
However, these general rules may have exceptions, and the application of the statute of limitations can vary based on the specific circumstances of the debt and any actions taken by the debtor or creditor.
Important Points to Consider:
Acknowledgment of Debt: Acknowledging the debt, making a payment, or entering a new payment agreement may restart the clock on the statute of limitations.
Debt Collection Practices: Even if the statute of limitations has expired, creditors or debt collectors may still attempt to collect the debt. However, they won’t be able to successfully sue you for the debt if the statute of limitations has expired.
Credit Reporting: The statute of limitations for debt collection is different from the time frame in which debts can appear on your credit report. Typically, negative information, including unpaid or delinquent debts, will fall off your credit report after seven years.
Check your state laws- in Texas this would be illegal and you wouldn’t have to pay the bill
If you’re in Texas, I just found out about a law for timely billing… it States that companies only have 11 months and one day to bill you for services rendered.
So they can’t come to you a year or two or three after they did some thing and say that you owe them more money…
Nope. Tell them the bill they think you owe is now an issue between them and your insurance provider at the time.
Should be uncollectible. Likely the billing group changed or the debt was bought by a collector. Possibly found by audit and this was an attempt to reconcile the books. Biller is SOL
You’re getting a mix of some good advice, some bad advice, some speculation, and some misinformation. There’s lots of different things that could be happening here, so it’s hard for anyone to give you advice. But here’s a few things that could be going on;
If the care was received at an in-network facility, and all providers involved are in-network;
1. **Untimely filing.** Healthcare providers, in their contracts with your insurance, have to submit claims for reimbursement in a timely manner, otherwise they cannot get paid by the insurer. Usually in CA it’s 365 days from the date of service (though there are some exceptions, including MediCal, which is 3 years). If they fail to do that in time, sometimes they’ll try to collect the total amount directly from the patient. This violates their contract with the insurer, and you should not have to pay it. To confirm if this is the case, check the insurer’s website for claims that correspond to the specific service/visit they’re billing you for. If there isn’t one, you contact the insurer for help.
2. **Lengthy Appeal.** Sometimes healthcare providers submit claims, but are unsatisfied with coverage decisions/amounts insurers will pay. For example, if they deliver a complex service, but insurance only pays them for a simpler service and denies coverage for some parts of it. In that case, the provider may appeal that decision on your behalf, and enter into extended negotiations with the insurer to try to get paid more. Those negotiations can take months, or in some cases years to get processed. You may have received this bill at the end of those negotiations. In which case, you may be responsible for paying it. To resolve this, check the claims on your insurer’s website and see if any portion of this visit was denied, and then updated. To resolve this, you may be able to appeal again. If not, the debt is likely yours.
3. **Slowpoke billing.** If the provider submitted the claim in a timely manner, and was satisfied with the coverage decision, sometimes internal dysfunction can mean they fail to send out a bill for the patient responsibility. Generally this is not illegal. That is, if they submitted a claim, and your insurer made a coverage decision and determined the amount that you owe, the provider can collect that amount at their own pace. This is an anti-consumer practice, because a non-diligent consumer may have wished to appeal some portion of the claim (e.g. if a procedure should have been covered at 100% rather than with 10% cost sharing). However, it is ultimately the consumer’s responsibility to check their insurer website at the time to see if/when a coverage decision is made and how much they are expected to pay, even if the provider doesn’t proactively send you a bill. The only limit on their ability to collect is the state’s statute of limitations on medical bills, which in California is 4 years.
If care was received at an in-network facility, but some part of it was determined to be out of network.
1. **Illegal Balance Billing.** Sometimes even at an in-network facility, you may encounter providers who are out-of-network. This can be common for procedures (say an anesthesiologist was covering a shift), labs, or emergency care. When that happens, those providers still want to get paid, even tough they don’t have a contract with your insurer. They will submit a claim, and receiving some amount. But if they are not satisfied with that amount, they can attempt to bill the patient for more. Under California law since September 1st 2017, patients are generally protected from this kind of billing, subject to certain requirements (e.g. if they provide consent to receive out-of-network care at the in-network facility prior to the service). To see if this is the case, you should check your insurer’s website for the relevant claim, and see if the services you are being billed for were determined to be out-of-network. If so, you would contact your insurer and tell them you are receiving a Balance Bill from an out-of-network provider. They will be required to negotiate with the provider to resolve the issue amongst themselves. You may still be required to pay any amounts that you *would* have had to pay if they were in-network.
If the care was received at an out-of-network facility.
1. **Out of Network Cost Sharing.** If you willingly went to an out-of-network facility, or willingly received out of network care at an in-network facility, they likely submitted a claim to your insurer, and you have a patient responsibility based on your benefits for amounts not covered. This would include a (probably high) patient deductible, and (probably high) cost-sharing portion for amounts above that. To verify, check your insurer website to see if there is a claim matching these services, and what it says your out-of-network patient responsibility should be. If they match what you are being billed for, you will be required to pay the bill. If the amount is *more* than that, you may also be receiving a balance bill. Whether or not you’re required to also pay that amount will depend on the above – i.e. whether it is illegal balance billing or not.
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So those are the main scenarios that could explain what’s happening. You need to figure out which one it is so you can understand how to proceed. In any of these scenarios, once you are confident that it is/isn’t an amount you actually do owe, you may have luck negotiating the amount down. However be advised that making such an offer to negotiated counts as you acknowledging the debt as yours, and therefore resetting the statute of limitations on collection. So do so cautiously.
If I had to guess (and this is completely a guess since you haven’t shared the specifics of the bills or claims), “Amounts not Covered” to me suggests that this is either Slowpoke Billing or Out-of-Network Cost Sharing on claims that were submitted and finalized quite a while ago, and they’ve realized that the clock is ticking on the statute of limitations to actually collect on it. That is, they dropped the ball on sending you a bill before, and are hoping that they still have time to collect from you.
Sometimes the dates on the statute of limitations can be fuzzy – it could be from the date of service, or it could be from the date of a finalized appeal or coverage decision, which in your case may be within the time limit. If you wanted to contest the bill on the basis of the statute of limitations expiring, you would send them a debt validation letter, and see what happens. They may nonetheless continue to bill you or even take you to court to try to collect, in which case you would appear and try to use the statue of limitations as a defense.
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>I’m not willing to let my credit get ruined by simply ignoring them
It won’t be that bad. New rules at credit bureaus
1. Drop medical collections completely once paid off or resolved, so there is no memory on your score of a medical bill in collections once you pay it, it gets removed. Though it could stay on your report for up to 7 years
2. New scoring models considerably lower the weight of medical collections in their calculations, making them less impactful. However some lenders may still use older models, so your experience may vary if you’re shopping around for mortgages or car loans.
I had a dentist try that.
My ex-wife went to the dentist but my insurance was now covering the costs.
They wouldn’t charge the right insurance, I told them multiple times, they kept getting denied on my ex’s old insurance.
After a year I told them that they had the correct insurance to bill, I repeatedly gave it to them. They said it was too late to charge the correct insurance and to pay them now.
I told them to FO.
Hospitals sell debt to outside/independent organizations that collect/charge the full price of the service. That’s one reason it can be delayed longer than you’d expect. It sucks.