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Ely
Ely, Counselor at Law
Category: Consumer Protection Law
Satisfied Customers: 86703
Experience:  Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
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In March, 2011 my father was in a nursing home and was admitted

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In March, 2011 my father was in a nursing home and was admitted into a hospital due to a urinary tract infection with other complications. Medicare paid the bill then September, 2013 determined the bill was paid in error and backed out the payment. The hospital is now trying to collect from my parents. There was a secondary insurer who claims they are not liable for payment since the bill is over 2 years old. What recourse would my parents have?
Submitted: 8 months ago.
Category: Consumer Protection Law
Expert:  Ely replied 8 months ago.
Hello friend. My name is XXXXX XXXXX welcome to JustAnswer. Please note: (1) this is general information only, not legal advice, and, (2) there may be a slight delay between your follow ups and my reply.

I am sorry for your father's situation.

The first thing that your parents may wish to do is to check the contract of that secondary insurance. Even if they are not covered by it anymore, the insurance policy should still cover the bill from the time of coverage.

There may be a "window" within which the secondary insurance policy requires one to file a claim, i.e. six months, one year, etc. It is best that this is confirmed. If there is a window and your parents have missed it, I am sorry to say that there is little recourse.

If there is no window, or, if there is a window but your parents are within it, then the secondary insurance has a duty to cover the bill.

If they do not, your parents may sue the second insurance company. To sue in a state court, one needs to have a "cause of action." There are numerous causes of action, such as "breach of contract," "negligence," "fraud," "unjust enrichment," etc., as well as causes of action rooted in statutory law. Every state has their own although they are very similar to each other in every state because they all stem from the same common law. A pleading in Court needs at least one cause of action, although it is not unusual to have more than one.

Here, this may be for breach of contract and negligence.

Bunting v. Progressive Corp., 809 N.E.2d 225, 235 (Ill. App. Ct. 2004) (applying Michigan law and noting that to state cause of action for breach of contract in Michigan, plaintiff must show: (1) valid, enforceable contract; (2) defendant's breach; and (3) damages resulting from that breach.

The elements of an action for negligence are (i) duty, (ii) general standard of care, (iii) specific standard of care, (iv) cause in fact, (v) legal or proximate cause, and (vi) damage. Moning v. Alfono, 254 NW 2d 759 - Mich: Supreme Court 1977.

By not paying the bill the insurance is supposed to cover, the insurance company is arguably liable for those two causes of action, then.

I hope this helps and clarifies. Gentle Reminder: Use the reply button to keep chatting, or please rate and submit your rating when we are finished. You may always ask follow ups at no charge after rating. Kindly rate my answer as one of the top three faces and then submit, as this is how I get credit for my time with you. Rating my answer the bottom two faces does not give me credit and reflects poorly on me, even if my answer is correctt. I work very hard to formulate an informative and honest answer for you; please reciprocate my good faith.
Customer: replied 8 months ago.

Thanks Ely. I understand there is a statue of limitations for collecting bills in Michigan. I have heard it may be 2 years but from my research it appears to be 6 years. Which is accurate?

Expert:  Ely replied 8 months ago.
You are very welcome, Al.

Thanks Ely. I understand there is a statue of limitations for collecting bills in Michigan. I have heard it may be 2 years but from my research it appears to be 6 years. Which is accurate?

It is 6 years. Six years from date of last payment or whenever the account became due, whatever's latest. §600.5813.

Gentle Reminder: Please use the reply button to keep chatting, or rate and submit your rating when we are finished. You may always ask follow ups at no charge after rating.
Ely, Counselor at Law
Satisfied Customers: 86703
Experience: Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
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