Linda Brandwin, R.N. 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.

Surgeon's office billing practices absurd
Sept. 19, 2003

Q: I had eye surgery a year and a half ago. I received a copy of what the insurance paid and what was not paid. I paid the amount I owed. About ten months later the company I worked for declared bankruptcy. The group insurer sent us a letter stating that if I had any outstanding bills, submit them right away. No claims would be paid after 60 days upon receipt of this notification. I had no outstanding bills, so I thought nothing of this. Then three months after this letter arrived, I received a bill for $1500 from my eye surgeon. This bill was sent to me one year and three months after my eye surgery.

I called the surgeon's office and the billing person told me this was an additional bill to what I had already paid. She said the office had been submitting this claim to our insurer but they had not paid it. I asked her why I had not been sent this bill earlier and told that my insurer had not paid. She said the office just doesn't do that.

If the surgeon's office sent me a bill right away I could have had this problem straightened out immediately. My insurance company probably thought it was a duplicate bill as that had happened quite a bit in the past. All I had to do was call and tell the insurance company that it was not a duplicate and they would pay the bill. It was one year and three months later that I received this bill. I feel this was bad bookkeeping. I don't know how they can expect me to pay for this now that I no longer have this insurance. Can you give me some advice? $1500 will really be a hardship for me to pay.

A: Not only is this bad bookkeeping, the billing practices of this office are absurd. The healthcare provider has an obligation to bill the insurance company and the patient in a timely fashion. Most insurance companies do not accept claims that are over six months to a year old. You shouldn't have to either. I find it very hard to believe that the billing office has been trying to submit this bill for fifteen months and to no avail. It was their responsibility to notify you within the first few months that they were having problems with this claim.

Call the eye surgeon's office back and speak to the office manager. Explain that this claim would have been processed if you were notified in a timely fashion. Fifteen months after your eye surgery does not qualify as timely. If this claim was properly tracked by the billing office, you would have been notified much earlier and the insurance company would have paid the bill. This is not your fault. Hopefully, the office will accept responsibility for their oversight.

If there is still a problem, speak to the eye surgeon himself. He should be made aware of how his billing staff is handling his claims. He may want to check his accounts receivable and his outstanding unpaid claims.

If all else fails and you are still being billed, call your State Insurance Board. There may actually be a law regarding the amount of time a healthcare provider can wait to send you a bill. You can also check with your State Medical Board. They may be able to provide you assistance also.