Legal Question in Insurance Law in Pennsylvania

I had a procedure done by a dermatologist on 5/26/2011. They took my co-pay and insurance information. I went back for a follow up and was told my claim was filed with the insurance company. December 2014 I received a bill from a different dermatology office saying I owe them the full amount because the services were submitted after payters responsibility for processing. I tried contacting them numerous times on the phone and the mail box was always full. I finally sent an email the end of December 2014. I never heard anything back. I contacted BC/BS in Feb 2015 and was told that providers have 2 years to submitt billings and after that they will not be paid and the patient is not responsible. They said an account team would contact the derm office and explain this and the charges would be removed. On Friday I received another bill from them with a letter stating they reviewed my record and I owe them the money. Do I?

Asked on 11/30/15, 12:18 pm

1 Answer from Attorneys

Solomon Weinstein Solomon Weinstein, Esquire

I would ask BC/BS to send you something indicating that you are not responsible for any medical bill due to the failure to submit a timely billing. I would ask them to send you the language from which they base their opinion. i would inform them that you are still receiving billing on the account. They may be entirely correct that there is no responsibility or they may be partially correct that they BC/BS have no responsibility However generally medical service bills are like a contract for services with a four year statute of limitations. Since the service was performed in May 26, 2011 and this is more than four years later it is probable you have no liability in any regard. If they persist in bothering you I suggest you contact an attorney to contact them and let them know that their action will not be tolerated. if you would like to make an appointment with my office feel free to call to schedule.

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Answered on 12/01/15, 9:09 am

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