Legal Question in Health Care Law in Illinois

I received a bill form a doctor that treated my daughter 01/10/2008, I received the bill 02/27/2010. My insurance company does not have records that old, but can tell me that I fulfilled my deductable in 2008. The bill is 392.00. My insurance company stated that the doctor�s office has 1 year to submit the bill. The doctor�s office stated they submit and did send me proof. I have a bill I payed this doctor in 01/23/2008 of my balance of $8.06 that I payed. Am I still responsible for the bill that the doctor�s office never followed up on until November 2009? In November 2009 the insurance company told the doctors office that the deductable was not payed so it�s my responsibility. Also the insurance company also stated that the doctor�s office only has one year to submit. I want to know if I have any legal standing on not having to pay a bill that the doctor�s office sat on for two years.


Asked on 3/04/10, 6:22 am

1 Answer from Attorneys
Stephen Messutta

It may depend on a lot of things. You seem to have a handle on the process and paid your portion, meaning the doctor was supposed to have submitted and received his/her portion. If your doctor accepted your health insurance the doctor accepted the terms and conditions of payment. While the bill is still yours, the doctor has severely prejudiced you and depending on the program may in fact have to write it off. I can not say whether the insurance company may still owe you a responsibility to pay you instead of the doctor, however, in a situation like this. At the same time I find it extremely hard to believe the insurance company has not kept records that are only 2 years old at this point. You may need to talk to someone higher up in the insurance company about this first.

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Answered on 3/18/10, 3:09 pm


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