I’ve been getting a series of notifications from Oxford that they haven’t paid out any money to a clinic for a series of procedures and tests my wife and I had last year. These notices show that over $3,500 in claims haven’t been paid because the clinic failed to submit the claim within 90 days of service.
What happens now? If the clinic doesn’t get its money, are they now going to go after us for the sum? And what ought we to do, considering the clinic participates in our health plan, had all the information required to submit a claim, but didn’t do so in time?
The clinic hasn’t tried to contact us, much less bill us. What normally happens in situations like this?
They probably will come after you for the money. I would go and talk to them. It’s not your fault they screwed up the claim, but maybe you can work with them to get it straightened out. If they put it in and were denied, the next step would be to appeal the denial.
Depends on if the clinic has a contract with Oxford, and if so, what terms are written into the contract.
If there is a contract, there may be what are known as “timely filing” requirements. If the provider doesn’t file timely, the claim is rejected, and the provider has to write the balance due off.
Obviously we are not privy to the contract. Call Oxford and see what the deal is.
If worse comes, You can surly negotiate with the clinic. They do charge more to insured party’s and when faced with an noncollectable may settle for much less.
IamnotSpartacus is correct. If the clinic is contracted there are certain things they are obligated to do. Unless their billing department is staffed with people who don’t know what they are doing then they know what the timely filing requirements are for the different insurers they bill to and if they don’t meet them then it is the clinic’s financial loss. The contract would specify that they can not collect from you. Definitely call your insurance company and be sure to document when you called, who you spoke to in which department, and what you were told. If the clinic were to try to bill you, then you’ll have this info at your fingertips, which will do alot to keep your stress level in check
