We recently received an inquiry regarding the timely filing of insurance claims and where the responsibility of a denied claim lies.  As many offices may be faced with this similar situation, we would like to share this helpful information with you.  Names have been changed to protect the innocent.

Situation/Question presented:
Situation is we have a patient who was seen two times in our office for a PI $395.  Our policy is to bill the auto med pay portion of the patient’s auto policy. So we billed their auto insurance.  Two months later his wife asked us to bill their health insurance,  so we did .  Months later the bill still was not paid by either insurance  so we resubmitted to the health and it was denied for timely filing saying they did not receive our initial billing.  So before billing the patient I called the auto insurance to see if we could seek payment from them. I was at that point informed they settled with the patient like 8 months ago. they would not tell me the amount but did confirm they had all our claims on file.  I then put together a letter to the patient along with a bill for the full amount.  The patient recently called me disputing this bill saying that in the state of WI  there is a law about collateral source of which states she is allowed to collect from both ins companies and that because of that she is not responsible for the bill.  She said their health insurance  told her because we did not send the bill in time that she is not responsible for it.  She basically is refusing to pay and is threatening us hearing from her attorney if we pursue her.

The way I see it is even if there is a collateral source it doesn’t have anything to do with us. She tried to collect from both parties and it didn’t work out so now she is mad she isn’t profiting from her injuries if she ends up paying us.  As far as her health telling her she isn’t resp. because we didn’t send it in on time. I don’t think they can say that. Isn’t she still responsible no matter what? I have two different lien forms signed by the patient.  I don’t believe we are doing anything that an attorney would even bat an eye at.  We are talking about two visits totaling $395, is it worth it???
I’m just confused on how to move forward with this and wanted to get a second opinion  on this matter before I do so.

Frustrating Billing Clerk
Sample Chiropractic Clinic

Dave’s Response
You are correct. The patient is personally responsible for the bill. Her auto medpay was primary and should have been billed first (which you did). You should have received a denial from them (not sure why you did not, but you can request one) and that should have been forwarded to the health insurance  for any “timely filing” concern.

I have attached an article on disputing the health insurance timely filing claim.  Article
Her attorney (if he or she is ethical) will tell her the same thing, that she is responsible for the bill for services rendered.
So you can do a few things here: rebill to health insurance (disputing the timely filing denial) and balance bill the patient for her portion (deduct/copay/coinsurance) or just send the patient to collections.

I would try the nice approach first and rebill to the health insurance . Make sure you document your collection efforts because I’m sure she will dispute the collection agency.
Thanks, Dave