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.

Billers need to explain two-year delay
Sept. 26, 2003

Q: For the last two months I have received a statement from my doctor's office concerning an outstanding balance for two doctor's visits that were from two years ago. My husband and I had physicals and paid our $10 co-pay at that time. I have long assumed that these bills were paid and wonder why I am being billed for them now. If these bills were not paid, isn't it too late? Will my insurance company honor them after two years? Wasn't it up to the doctor's office to file these claims? I use this doctor because he is on my doctor's list from my insurance company.

A: I also wonder why you are being billed now. Call your insurance company first and find out if they have received these two claims and if they were processed. If the claims have not been filed, ask the insurance company if it is too late to submit the claims. Many insurances companies will not accept claims more than a year old. If the claim has been processed, ask what was paid and what your responsibility is. Now you will have an idea about the status of these bills before you talk to the doctor's office.

Call the billing department at your doctor's office. Ask them why you are being billed two years after your visit. Being billed after two years is not reasonable and it is inexcusable. The billers need to explain their untimely delay.

If your claims have not been submitted, it is up to that office to submit them. Since the doctor is a provider with your insurance company he has a contract stating all of your claims have to be submitted to the insurance company before you can be billed. You paid your co-pays, you did your part. Now the doctor's office has to do their part. If it is too late to submit these claims, that is not your fault. Your doctor's office is responsible for this problem. If they continue to bill you, call your insurance company and explain what is going on. They will be able to help you. Also let your doctor know about the billing delays in his office. Tell him that being billed two years after your visit is not reasonable for you or his practice.

If you found out when you called your insurance company that your claims were processed, make sure the amount you owe matches the bill from your doctor's office. Make sure the doctor's office posted the payments and the provider discounts or disallows accurately. Perhaps the amount you owe is part of your deductible. All discrepancies need to be corrected.