If a patient provides insurance information to a hospital for payment, what responsibility, if any, does the hospital have to file with the insurance company?

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When it rains it pours... but when the blessings come they overflow!

If you are contracted with the insurance company, you are liable via contract.

If not contracted, then I would say No, but you do it as a courtesy to the patient.

Why would you not want to file the claim?


Hope this helps.

Ms. Flatlander

Thanks Ms. Flatlander..

Specifically I wanted to understand if the Hospital has any legal responsibility to submit the claim to insurance when you have provided them with the insurance information. In other words, if they take your insurance information and state that they will submit the claim and they don't... are they liable when the timely filing has expired? Especially when they didn't contact the patient about the outstanding invoice until after the timely filing had expired.

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When it rains it pours... but when the blessings come they overflow!

I just reread your post again. Okay.. so if the hospital has a contract with the Insurance carrier, (which in this case they do), then you are saying that they would be legally liable via contract? Do you know where I might be able to find this documentation in order to take to court with me?

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When it rains it pours... but when the blessings come they overflow!

Faith, I googled a bit and found a few things..

"As a courtesy to patients, the Hospital submits bills to your insurance company and will do everything possible to expedite your claim. However, it may become necessary for you to contact the insurance company or supply additional information to them for claims processing requirements or to expedite payment. You should remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment of your hospital bill."

But then, I found this on a talk forum.. don't know for sure what the extenuating circumstances are but this would make me feel better knowing I might have some recourse according to this poster.. like I said, I don't know if they know what they are talking about but she does have good suggestions:

"The insurance company CAN and will pay for the event: even if the bill is five bloody years old.

You call that incompetent so and so back and demand to speak with a supervisor. You appeal their decision to NOT pay. If the company still refuses to honor their obligation? You call and file written complaints with the insurance comissioner AND the attorney general of your state. You go into court and state that you do not owe one dime until after the insurance companies have dispatched their obligations. And a judge will stand behind you. It's insurance law! And you outline exactly what you have done to get the companies to comply and add to your listing the copies of the letters that you filed. The hospital can not argue the: "You said you were 'self pay', " when they were repeatedly given insurance information. Hospitals get fines, too! For exactly this type of crap. Your complaint to the inurance commisioner and the Attorney General will also be about the unfair billing practices they hospital employed prior to and after they engaged the credit agencies rather than billing properly....

And whether it's HER insurance company or not, you call and do the same thing to them!!!!

I am dead serious.

The insurance companies HAVE to respond in a timely matter to an Insurance Comissioner complaint and to the Attorney General. And an explanition that you didn't meet "Timely filing" requirements when that was NOT your fault but the hospitals inability to bill properly does not cut it with the insurance commissioner or the state attorney general. This means fines for insurances companies for failure to honor their obligations.

In addition, the provider (the hospital) was told that they could NOT bill you for THEIR lack of filing on time and that the bill was THEIR responsibilty and NOT YOURS!!!! You are not responsible for this bill until the hospital and the insurance company have done what they should have done. This is why you agreed to have the hospital bill the insurance company and assigned the insurance companies to pay the hospital on your/wife's behalf.

Find that Explanation Of Benefits (EOB) and most likely you will find that the liabilty for the bill fell squarely on the shoulders of the provider and NOT ON YOU. And, if it didn't? I'd start looking around to see if there is a different insurance company that I could join. In the meantime, the insurers need to quit monkeying around and pay the bill.

OH!!! And make sure you give a copy of all this crap to your HR department. With employer group plans, the EMPLOYER, can also waive the timely filing requirement, as well. And your bringing this up may also make the employer consider another company....

Need to know where the addresses of all these folks are???? It's in your policy under the APPEALS section! "

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" You've Been Thunder Struck ! "

Thanks Karrie. Yes that helps some. I have almost the same issue going on that you posted above. I provided the hospital my insurance information and they never filed with my insurance carrier. They contacted me 1 month after the timely filing expired. They went ahead and finally submitted a claim to the insurance company but it was of course denied for timely filing purposes. So now I am being sued for the Emergency Room bill and I was told that there was nothing I could do but pay the amount. I asked for a continuance because I need time to understand more of my rights. I might just have to file a complaint with the Insurance Commisioner. Or atleast call an attorney for a legal consultation.

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When it rains it pours... but when the blessings come they overflow!

Have you contacted your insurance company about this?

Faith, did the hospital not ever send you bills for the emergency room visit? If so, didn't it say something on the bill about filing (or not filing) insurance?

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"The worst sin towards our fellow creatures is not to hate them but to be indifferent to them: that’s the essence of inhumanity." -George Bernard Shaw

Hi Sweetdaisy! How are you?

I had moved 3 times during the 2 years and I never received a bill from the hospital. The attorney stated that they sent out one bill and received it back. My work number has been the same for almost 7 years now. The hospital contacted me on my work phone number regarding the outstanding bill exactly 1 month after the timely filing had expired. They then submitted a claim to the insurance company for the first time and it was denied.

I had to go to court on Monday b/c I was being sued for the balance from a collection agency. The judge wasn't even there! They had all the plantiff's and defendants that were present to go out in the hall and try to agree on arrangements. The lawyer I had to speak to for the hopsital was spouting off law 100 miles an hour to me and told me that my only option was to sign his paperwork that I would pay off the bill. I told him that I wouldn't sign anything until I understood my rights better. He finally agreed to continue it until 12-21.

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When it rains it pours... but when the blessings come they overflow!

I can imagine the bill is probably quite large, if it was for the ER, and if you've been turned to collections, your credit will suffer. You certainly need to follow some of the advice above: contact your insurance company and see if they will process the claim; if they refuse, contact the insurance commissioner to file a complaint; and most definately contact a lawyer. Check with your employer and see if they have an Employee Assistance Program...if they do, you likely have legal services available to you for free or a discounted rate.

The fact that they sent one bill and received it back, yet never tried to contact you at work is troublesome to me. I used to do medical collections YEARS ago, and we did our research and tried every avenue of contact before turning folks over to collection agencies. But maybe we were just nice.

Good luck to you, Faith! Keep us informed of what happens.

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"The worst sin towards our fellow creatures is not to hate them but to be indifferent to them: that’s the essence of inhumanity." -George Bernard Shaw

As a medical professional, I'll shed some light here.

Really, the hospital files insurance as a common courtesy to the patient. But, in the end, the patient is responsible for payment of services. If a hospital is a provider for a certain insurance company, the hospital is legally obligated to abide by their pay scales and accept their discounts.

BUT, in the end, the insurance is a contract between the patient and the insurance company. If the hospital refuses to file, it's up to the patient to file.