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Law Educator, Esq.
Law Educator, Esq., Lawyer
Category: Consumer Protection Law
Satisfied Customers: 116736
Experience:  Attorney experienced in commercial litigation.
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I received a notice from the hospital that I owed them money

Customer Question

I received a notice from the hospital that I owed them money from a service date of 1/13/2015. They said they renegotiated with my insurance
Company now as of 7/16/2015 which is true as I just received an explanation of benefits saying that the insurance renegotiated and I owe the difference they did not pay. Because it is over a year old do I have to pay it?
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Law Educator, Esq. replied 1 year ago.
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Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

If service date was 1/13/2015, how is it over a year old?

Customer: replied 1 year ago.

Service date was 1/13/2014

Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your reply and correction on the date you posted.

If the hospital was negligent in their billing practices and failed to properly file with your insurer thereby causing you prejudice because you could not file for the insurance after 1 year, your first recourse is to resubmit to your insurer informing them of what happened and state specifically you are appealing the denial as this was caused through the hospital's fault and negligence and not your negligence.

Then if the insurer refuses to reconsider, your next step is filing a suit against the hospital and insurer both for breach of contract and negligence in taking so long to do this and thus causing you harm and prejudice contrary to the terms of your contract.

Unfortunately, you will have to sue them if you cannot get the insurer to overturn their denial and renegotiation on your appeal, as that would be your sole recourse remaining.

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