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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Time
limit for medical claims' submissions varies
July 2, 2004
Q:
Is
there a time limit on how long a doctor can take to
bill my insurance? It is been over five months and my
insurance company says they never received the bill.
Maybe my doctor doesn't need the money!
A:
The
time limit for medical claims' submissions depends on
the individual insurance company's policies. Some insurance
companies will only accept claims within three months
of the date of service, some a year, and some companies
will accept all claims no matter what their age. Policies
vary widely.
Just
because the insurance company says they have not received
your doctor's bill, this does not necessarily mean that
the doctor did not submit the claim. There can be many
different reasons why the insurance company does not
see the claim in their system.
First,
the insurance representative may not be looking in the
correct place to find the claim. Many times I have repeatedly
asked for information and been told by one representative
that the claim is not there and another one finds the
claim easily. I can not explain this discrepancy. So
the claim could actually already have been paid or possibly
the claim could be in the middle of being processed.
The
doctor's office may have sent the claim to the wrong
address or with incorrect information. Hopefully, if
the doctor's office tracks aged claims, they will find
their error. They will check the insurance claim with
the information on the copy of your insurance card.
Often
the doctor's office submits a claim correctly, and for
some strange reason, the insurance company never receives
it. It is like the claim simply disappears. I have no
idea why this happens or where these claims end up.
Again, hopefully, the billing department will track
their aged claims and resubmit the bill.
There
could be many more scenarios as to why it appears that
the doctor has not submitted your medical claim, including
the fact that it was just overlooked and never submitted
to begin with. If you are concerned, call the billing
department at your doctor's office and ask for the status
of this claim. Between the billing department and your
insurance company, you will be able to find out precisely
what happened to your medical bill. Remember, you just
can't assume anything when it comes to medical bills
and claims.
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