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This Web site contains a compilation of more than a thousand consumer finance  columns written by Tony Novak from the 1980s through 2006, updated and reformatted for maximum usefulness today.  New material was added after 2010.

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Late insurance claim settlement

originally posted: 11/22/2006  reposted: 2/18/2011 This post has not been recently reviewed or revised by the author and may be out of date. If you notice an error or are in doubt, please send a new question by email or ask for an update. Email

Q: My step-son went to physical therapy and he never bothered to give them his insurance card and never bothered to let me know about that, so the bill was never submitted to you for payment/claim. Now it has been sent to a collection agency and I need to get it taken care of. My question is, who/where do I send the bill, and will it still be covered?

A: Most insurance policies allow medical bills be submitted up to 6 months after treatment. The contact information for claims submission is included on the ID card and in the back of the policy itself. In most individual health insurance policies, the cost of outpatient physical therapy treatment barely exceeds a typical $1000 policy deductible, so insurance usually does not play a big role in paying for physical therapy for commercial insurance patients. The objective is to choose a deductible that is high enough to bypass the expensive insurance procedures for these smaller medical bills and save enough in insurance premiums to be able to pay smaller amounts out-of-pocket. The more significant issues are: 1) If no third party payer arrangement was made in advance, then there is no assurance that the service provider will accept the health plan's approved amount as full payment. You may not benefit from PPO discounts. 2) Obviously there is no 'assignment of claim' and no timely response to previous billing, which then makes the patient financially liable for the full amount of the bill. The lesson to be learned is that should always be some communication about payment between patient and medical service provider prior to receiving medical service - basically who is responsible, how much, and what billing procedures will be followed.


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