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Legalease
Legalease, Lawyer
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Experience:  15 years exp all aspects of general law
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I have a health insurance claim for an MRI where the provider

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I have a health insurance claim for an MRI where the provider had the wrong insurance information. By the time I was billed and I figured out the claim had not been paid, they advised me that I would have to send a claim directly to my insurance because it had been too long. So I sent a claim to my health insurance, I didn't realize until I was called by the provider months later that it still hadn't been paid. I contacted my insurance and was informed they needed more information; however I never received anything to let me know that my claim had not been processed. By the time they had the information they needed, the insurance said that it had been too long and they wouldn't pay. I have proof that I had this insurance at the time of service, is there anything I can do so I don't end up with a $1000 bill?

Hello there -

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How much time passed between the test and the last time they stated that they would not pay the bill?

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-Can you tell me what county you are located in?

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MARY

Customer: replied 3 years ago.

From the time I had the test and was informed my the provider that they wouldn't pay it had been about 7 or 8 months; but in between that time after getting a bill a few months after the test I sent my correct insurance information and assumed it had been taken care of. I didn't realize this was not the case until I was called a couple months later. From the time of the test to being told by my insurance that they would not pay it had been about 2 years. But I had contacted the insurance before to try and rectify the situation before this for about a year. [In case you are wondering why so much time has elapsed, I am in pharmacy school and honestly the claim was not at the front of my mind so I only took action after receiving bills from the provider saying again that the claim was not paid]

Customer: replied 3 years ago.

I am located in Baltimore County, MD

Hello again Megan -

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While 2 years is some time, it is still not enough time to say that they will not pay the claim (there are no legal limits to the time in which a claim can be submitted). My suggestion to you here is to file a complaint with the Maryland division of insurance -- they have an online complaint system located here -- http://www.mdinsurance.state.md.us/sa/consumer/file-a-complaint.html Their role is more of a mediation / pressure role on an insurance company but they generally do not order an insurer to pay a claim - so in the event that you do not have luck with them. my suggestion is to take the insurer to small claims court in MD -- you can sue for up to 5 thousand dollars in MD without using an attorney and by simply completing some forms -- the case can be brought in the county where you live or where their company is located. Here is a link to the MD judiciary website where you can scroll through and get information for your county and the forms needed to complete and apply for the small claims hearing. http://www.courts.state.md.us/district/ The small claims paperwork will ask you what the nature of your claim is -- legally, You have a breach of contract case as a beneficiary of the health insurance contract -- the health insurance company was contractually obligated to pay for the testing and they delayed payment and then refused it for an illegitimate reason (time lapse is not a legitimate reason, particulary since the statute of limitations for written contract claims is 6 years). I believe that the threat of a complaint to the insurance dept and a small claims action might work if you want to try enclosing the bill in a certified letter with a final request for payment and then go from there (if they do not respond to your letter within 30 days, then I suggest you go forth and file the insurance dept complaint at that point).

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Please let me know if you have any questions.

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MARY

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