Long story short, last year I was in a car accident that required me to be transported in an ambulance. I heard nothing from them from July to late in the year when I contacted them (stupid, I know. Maybe I should have just let them never find me idk that felt wrong too). They did not mention the bill, they did not confirm insurance information, nothing. Fast forward to early this year, I finally heard from them, and it's with a bill (for $4,500). The same day I received that bill I called my insurance and we had a conference call with the medical transport agency, and I thought everything was good and done. That's what I was told at least.
Nope!
Even though my insurance would have covered it at the time, because they submitted it to my insurance outside of the 180-day window, it was then declined. My insurance specifically states that I am not responsible for the bill and to not pay the provider, saying this:
"According to our records, we received a completed claim submission form from your provider on February 13, 2024, for your services on July 11, 2023. Kindly note, a claim submission must be received by [Insurance] within the timely filing limits set forth by the state regulator.
In California, the timely filing limit is 180 days from the date of service. That means [provider] had until January 11, 2024, to submit the claim. [Insurance] denied the submission of your claims due to the claim being submitted outside of the 180-day time frame to submit the claim and request payment. [Insurance] maintains that submission was denied correctly and is not eligible for coverage or reimbursement by your plan. Kindly note, the provider cannot bill you for these services."
So I call the the ambulance company and they in turn say: I AM responsible because they "didn't have my information correctly and that's my fault" even though I was literally in a car accident with a concussion and they didn't ask for my insurance information I guess, I don't remember. I also have documented that they DID have my phone number, as it is listed on the care notes from the EMTs so they could have contacted me. The location they transported me to also had my correct contact information.
I have filed two grievances with my insurance (tbh just for paper trail purposes), and just submitted another with the The Department of Managed Health Care. I have contacted the medical transport company and informed them of this, along with my realization that they did have contact information for me.
Who is right here? What authority is my insurance referring to when they say "the provider cannot bill you for these services"?
Ambulance didn’t bill my insurance within 180 days now I am stuck with the full bill
byu/Intelligent_Gate_227 inInsurance
Posted by Intelligent_Gate_227
5 Comments
They’re failure to bill properly is their issue.
Another avenue is the no surprise medical billing laws. It was a covered service they can’t pass the bill down to you. This may be what your insurance is telling you when they say they can’t bill you.
Looks like you file complaints with all the right people and hopefully it’ll work out without much more stress. But you don’t know them anything.
Typically insurance companies set the timely filing guidelines because of the contracts with insurance companies, but it looks like the state of California is setting the 180 guideline based on the “state regulator” verbiage. Of course the ambulance company is spouting nonsense, and you did the right thing to contact your insurance and the California insurance commissioner.
Are you dealing with a billing company for the ambulance or are you directly dealing with the ambulance provider?
Do you know if the ambulance provider is a government agency or a private company?
a failure to submit a claim in a timely fashion is 100% on them, it’s not like they don’t know the rules in their own area, they will try to squeeze you of course, tell them to go fish and if they keep bugging you tell them you’ll report harassment to media and reg authorities
Tell ambulance company you will see them in court with the news.. they are incompetent