Legal Question in Credit and Debt Law in New Jersey
2 1/2 year old hospital bill
My mother, who is 79 years old and on a fixed income, received a 2 1/2 year old hospital bill for $1,900 related to my father who passed away in July of 1996. He was covered by medicare and a secondary health insurance. We believe that the hospital did not submit the bill to the secondary insurance company in a timely fashion and that they (the hospital) are now trying to get the money from us. What if any legal obligation do we have to pay this bill? If a collection agency comes calling, how do we handle that? we have talked to the hospital numerous times, but they keep sending the bill and tell us to speak to the secondary insurer. The secondary insurer tells us that the hospital didn't submit the bill in time.
1 Answer from Attorneys
Re: 2 1/2 year old hospital bill
First, put your reply to the hospital in writing.
Second, either get in writing a statement from the insurer stating that the claim was never submitted in writing but the alleged service WAS a covered proceedure. If they won't put it in writing, note the first and last name of the rep of the insurance co. that tells you the hospital didn't submit the claim but the claim was a covered proceedure, noting the time and date of the call in your letter. Also give them the relevent insurance information one last time.
Third, tell the hospital in writing, that they are NOT TO CONTACT YOU AGAIN regarding the debt unless they do not get full/partial payment from the insurer and can produce proof of the unpaid balance due.
Worst case scenarios: 1) they did submit but didn't get paid - NOT your problem if it was a covered proceedure! 2) IF the insurance company does pay but not in full, there may be some co-pay on your behalf, but they must provide you with proof that the money they are asking for is $$$ you are liable for AND your insurer would not pay in full.
I've done this before... IF they contact you after your letter, file suit for violation of the FDPCA (Fair Debt Practices Collections Act)
If they sue you, file your answer timely, and go to court asserting tha hospital waived it's right to payment when they failed to submit their claim timely to the insurer (most insurers will only pay on a claim submitted within 365 days of service). You should also argue that by NOT filing timely, the insurance co. also prejudiced your rights and should be "estopped" from asserting you owe the debt. Both arguements are similar, but different. Unless you are fearful of talking to a judge, you shouldn't need an attorney.
Good luck!
Kevin Begley
Kevin J. Begley Attorney at Law
P.O. Box 332
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