Surprise: You Owe a Big Doctor Bill From More Than 4 Years Ago! Ouch...

Is there a statute of limitations for collecting on health care claims?  

It’s a question I never pondered in any of the hundreds of articles I’ve written on health insurance since 1988 until recently when out of the clear blue I received a bill from an orthopedic medical group that treated my left knee. Here’s the catch: services were rendered during the first quarter of 2010 – more than four and a half years ago.

The most painful part – even more so than what I felt in my knee all those years ago – was that the bill totaled $712.33. At the time I was treated, I could afford the out-of-pocket costs without any trouble. But now money is tight, so I panicked.

Then I sprang into action to investigate further. I started with a phone call to the insurance carrier I had at the time and explained the situation. They had to transfer me to a special department where I could request archived copies of all the so-called explanation-of-benefit forms, known as EOBs, that were filed (their call center only had access to claims dating back two years). 

The claims rep I spoke with said it was highly unusual for a doctor’s office to bill a patient more than four years after services were rendered, hinting that it was suspicious if not downright unheard of to him. I was told it could take at least a week for me to receive the EOBs in question in the U.S. mail.

Then I made two other calls. The first was to the doctor’s office billing department. I reached a very compassionate woman who felt badly that I would struggle to pay this bill and suggested that I could write a hardship letter. But she also said their only record of direct payments from me to their office involved $35 co-pays at the time of each office visit. Her final comments were that it appeared the insurance company didn’t process the claims properly, and that they’re allowed to collect on unpaid bills up to four years and were auditing claims due to a change in management.

Once the EOBs arrived, I was surprised to learn that not only did they reflect that out-of-pocket costs were owed by the patient (yours truly), but that their number was more than $100 higher than the final bill from that particular doctor’s office. My panic deepened.

So I then called a consumer hotline for health insurance matters in the state of California and the woman I spoke with said it appeared that the system worked as intended, EOBs were issued, claims were processed and I more than likely owed money. But she also supported my idea of ordering archived copies of credit card statements from 2010 and 2011 to see whether I paid the doctor’s office anything above and beyond $35 co-pays.

This time, the process was much easier. My credit card company allows its customers to request back statements and have them available for downloading within just 24 hours. It took me a few days, but, alas, I found a smoking gun! There was a charge for $623.11 tied to that particular doctor’s office.

My next step was to email the nice woman in the billing department with a heads up that I discovered this payment, then make copies for her office, along with the bill, which I hand delivered. Just hours later, I received a contrite e-mail from her apologizing for the mistake and informing me that they would waive a charge for the difference, which amounted to about $85, because my financial situation had changed so drastically.

The moral of the story reminds me just how important it is sometimes to grease the squeaky wheel. We have to be act as our own advocates on occasion, especially with something as complex and inefficient as paying health insurance claims.