Delayed Medical Bill

Question: Is there a time limit on how long a business can wait to send an additional bill for services rendered? I received a bill for a health device which was covered in part by insurance. The person in the doctor’s office called the insurance company and I was told how much I would owe and paid the total amount that day. A year and 5 months later, I received a bill for $111+ and was told when they were matching their Explanations of Benefits they found my insurance company did not pay as much as they should have. I have not been given any figures and have no way to verify this information.
Answer: The statute of limitations is four years for the sale of goods and five years for a contract for services not wholly in writing.

There may also be provisions in the contract between the doctor and your insurer that limit the doctor’s ability to submit a bill. Often, such agreements provide that any bill must be submitted within one year. Submit the bill to your insurance carrier and ask that they either pay it or take action against the doctor for submitting it so late.

Additional questions are raised by why your insurer refused to pay. Generally, insurance policies provide for payment of reasonable compensation for medically necessary services. Often, they limit the amount which the doctor can receive on some negotiated basis. If the reason the insurer refused to pay more was that the amount sought was excessive, the device was not medically necessary, or the doctor had agreed to take less, you are not obligated to pay the extra amount, and you should refuse to pay more.

You should not in any circumstances just ignore the bill. Document any refusal to pay and the reasons.

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