Legal Question in Insurance Law in Pennsylvania

in dec. 2008 my son broke his hand and our family dr. referred us to a surgeon. the summer of 2009 i got a call from that office letting me know they had lost our info and were trying to submit our claim only to find out they had 2007 ins. info. we gave them correct info and our ins. co. for 2008 denied the claim because it wasn't submitted in 90 days. we have offered to pay what the ins. co. would have paid theyy are not willing to negotiate and we are afraid they will put it to a collection agency and ruin our credit. help


Asked on 2/15/10, 2:45 pm

1 Answer from Attorneys
Richard Teitell Richard K. Teitell, Esquire, P.C.

1. Most health insurers require submission of bills no later than 90 days after the end of the year in which the services were provided. But you will have to check with your insurer to determine the policy requirements. 2. If the doc's office was negligent in its failure to timely submit the bills, you should not be liable to pay the amount that would have been paid by the insurer. 3. My suggestion is to speak with the office manager & try to reach some settlement. You should impress upon the office that their negligence should not become your problem. You should also impress upon them that if they turn the matter into a collection agency they will be buying a law suit- you will sue them & the collection agency under applicable Federal law. Good luck!

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Answered on 2/21/10, 7:02 am


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