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Maverick
Maverick, Attorney
Category: Estate Law
Satisfied Customers: 5767
Experience:  20 yrs of professional experience.
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I'm trying to close probate, I keep getting medical

Customer Question

I'm trying to close probate, I keep getting medical explanation of benefits saying the claims were denied by the insurance ($1,300), its been 15 months. The insurance says they are still processing, the medical facility has not sent me a creditor claim. Can I close probate without paying? Can they come back to me if the medical claim is denied?
Submitted: 5 months ago.
Category: Estate Law
Expert:  Maverick replied 5 months ago.

Welcome to Just Answer (“JA”)! My name is Maverick.

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1. What state are you located in?

2. Are you an executor under a Will?

3. I don't understand how the insurance company is telling you they are still processing the claim while at the same time sending you a denial. Is this really what's happening or am I missing something?

4. What does the medical facility say the estate owes it? Have you ever called to find out?

Customer: replied 5 months ago.
California, yes I'm the executor. The medical facility has requested a reconsideration of the claims submitted to the insurance company. The insurance is saying the facility did not properly receive pre-authorization for the services for my father. The hospital dropped the ball. The hospital says the total bill is $1,300 but that's if the claim is denied. Again, they have not filed a creditor claim against the estate.
Expert:  Maverick replied 5 months ago.

Based on this law, it appears that the medical facility's delay means the claim is now barred against the estate. So, if you provided them with proper notice under CA law then you should have no personal exposure. As the personal representative, you must have completed a Notice of Administration to Creditors (Form DE-157, Judicial Counsel) and you must have mailed to the creditor a photocopy of the signed Notice of Administration to Creditors form, together with a copy of a blank Creditor's Claim form (Form DE-172, Judicial Council).

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