Linda has an excellent idea. Here in Florida, I did that. Every insurance company I spoke with said they had a 90 day time limit. Ive sent claims 7 days after the patient was seen (this is because with emergency medicine, you have to wait for the hospital to send you the copy of charts and patient info) For example, patient seen on jan 1. Claim went out to insurance electronically on Jan 8. The insurance company denied the claim on Feb 15 for not submitting the claim within 90 days of date of service. When shown Florida has 6 month timeframe, they ignore this until a complaint is sent to the office of insurance regulation.
Every insurance company where Ive negotiated contracts with, want between 45 and 90 days for claim submission, when informed of Florida's time limit, the insurance company responds with, we have our own and every doctor agrees with our timeframe. Our contracts states claims will be submitted within claim submission timeframe under applicable State or Federal Laws. The insurance company;s dont like it, we tell them if they wish us to be contracted, this is a make it or break it requirement.
Most State timely filing laws are listed in the insurance laws.
Many insurance contracts I have seen do not allow patient balance billing if the provider failed to submit the claim within the contracted timelimit.
Our practice policy is, if the patient withholds insurance information until aftr the State time limit to submit the claim, we have the patient pay if the claim is denied. Howeverk we have been working with our cotracts to close this loophole. We have language added to state if the patient wilfully withholds correct insurance information until after any and all timely filing limits, we can still submit the claim and the crrier has to pay. The practice policy is if the billing company screwed up and didnt send the claim in a timely manner, we didnt hold the patient responsible for the screw up.
A couple of years ago, we had a huge problem with New York Medicaid paients withholding Medicaid info. They wee treated as uninsured . The account became delinquent and was sent to our collection agency. It was whe at collections that the patient revealed Medicaid coverage. We would get a call from Medicaid telling us we had to write the bill off. We refused. I wrote to the Department of Health and Human Services. CMS responded saying if the patient made a freedom of choice decision to present themselves as an uninsured or self pay patient, we were entitle to teat them as a self pay patient. Ive ised that letter to get medicaid and te medicaid HMO to pay the claim even after their timely filing limit