Legal Question in Health Care Law in New Jersey

Responsiblity for payment to health care provider.

My health insurance policy states that in order for a claim to be considered, the submission must be submitted within a year of the service provided. The health care provider submitted the claim 14 months after the service was performed, and therefore it was denied. Upon questioning the provider why he was delinquent in filing the claim, I was advised that the original claim was filed incorrectly and nothing was done til after the year elapsed. Should I be responsible for payment? The amount involved is $77.


Asked on 1/21/05, 2:15 pm

1 Answer from Attorneys
Adam L. Rothenberg Levinson Axelrod, P.C.

Re: Responsiblity for payment to health care provider.

If the claim was filed impoperly and rehected, it would seem that either the insurer is responsible, since htere was s filing, even if not proper. However, if the insurer does not pay and it is the fault entirely of the doctor, then you may have an argument that you should not have to pay the bill.

However, please be advised that the bill is yours since you got treatment. Your options are then to have either have the insurer pay it on your behalf or interpose a defense that the actions of the provider prejudiced you relieving you of your responsibility. That is a defense to payment, not an absolute bar to your obligation.

For $77 - I suggest that you try to work it out.

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Answered on 1/21/05, 2:29 pm


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