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Chris T., JD
Chris T., JD, Attorney
Category: Legal
Satisfied Customers: 4827
Experience:  Experienced in both state and federal court.
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I was on vacation three years ago in CA and needed to go to

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I was on vacation three years ago in CA and needed to go to the ER one night. Insurance claims were filed and paid in a timely manner. We never received a bill from the hospital. We just recently received a letter stating that we were PAST DUE!!! from an in-house collection source for the hospital. I called and told them that we were unaware of any problem for we had never received a statement/bill of any kind. They said the letter was my bill (no detail) and that they have not been able to send a statement because our insurance company had not paid their portion in full. The insurance company said that the hospital appealed, but appealed to late (outside of the contracted time alotment). The insurance company sent a letter and said that the claim was closed. This was over 2 years ago and still the hospital sent nothing to us. Are we responsible after so much time to pay, and to pay without a statement?

TexLawyer :

Good evening. I'll be assisting you with your question.

TexLawyer :

First off, this boils down to a breach of contract claim, so much of the ultimate answer will boil down to what the contract you signed at the ER says.

TexLawyer :

One way to knock something like this out right off the bat is often through the statute of limitations. In this case, the statute of limitations in California for breach of a written contract is 4 years, so you are within the statute.

Customer:

Unfortunately, I have no copy of anything anymore. We paid all other bills that were sent to us from the hospital. We do not know what we are paying for this time. We have no record because they have never sent a bill.

TexLawyer :

So, if you do in fact owe them the money under the contract they can hold you to it.

TexLawyer :

As a matter of law, they are only required to send you a bill within the statute of limitations.

TexLawyer :

You should call them and ask for a copy of the agreement you signed with the hospital.

Customer:

So, do we wait until they send us an actual bill, or do we have to pay from a letter stating that we owe a certain amount?

TexLawyer :

It is possible there is a clause holding you liable for all costs not paid by your insurance. You should ask them for an itemized bill. If they can't produce one, they will have a difficult time making out a claim in court, if it ever got that far.

TexLawyer :

To game it out to the end, if decided to never pay them, their last resort option is to sue you for the remainder of the bill. In court, the burden of proof is on them, so they would have to prove up their costs in court. If they can't do that now to you, they won't be able to later in court.

Customer:

They are claiming that they are not billing us for any amount that the insurance owes, just patient responsibility.

TexLawyer :

So, your co-pay?

Customer:

copay and deductible

Customer:

We have never received an itemized bill showing charges, what the insurance has paid, and what we owe.

TexLawyer :

OK. As long as they are within the statute, they can attempt to collect. There is no law requiring them to send you a bill within a certain time period (as long as it is within the 4 year statute of limitations). Again, you should make them prove to you that you actually owe the amount they say you do by getting an itemized bill and a copy of the agreement you signed.

Customer:

ok thanks!

TexLawyer :

If they can't produce both, they will have a very, very difficult time suing you in court. And they know it.

TexLawyer :

If they can do both of those things, however, you may be stuck, depending on what the agreement says.

Customer:

Understood.

TexLawyer :

Do you have any questions?

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