Need your expert help here...

My ex-wife had surgery to repair torn MCL back in March 2013. At this point I had already filed for divorce so she made sure she had the surgery done to ensure it went under my coverage and I was on the hook to cover expenses....not going to cry about that. I had paid what I thought was everything related to the surgery.

Fast forward over a year later and she starts getting billed for $705 from the facility that hosted the surgery. We seriously never saw a bill until over a year later! The insurance didn't get the bill until that time as well, so it wasn't something the insurance company screwed up.

Do I have any case to dispute based on them not billing for so long?

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Yes. Timely filing dispute. You should not be responsible for this. The provider needs to prove to the insurance company that it was filed in a timely manner. If they can do this, the insurance needs to process it, and you pay per your deductible / co-insurance. If the provider cannot prove this, they need to write it off.

If you have BCBS, Humana, or Aetna...they are very good at tracking down past claims that were filed.

If you have UHC or a few of the smaller guys...they are more prone to mistakes.

Either way, very unlikely you will need to pay...just will take several phone calls.

I did medical billing for six years.

edit: Unless the insurance documents were not properly provided to the facility. While many hospitals / PCP's do forward insurance info to all facilities, it is not their responsibility. Your ex-wife would have needed to make sure she provided a copy of the insurance card to the facility. This would be the provider's argument if they try to dispute timely filing. You / your ex-wife would then need to contact all the providers involved and make sure someone (your wife or them) provided insurance information.

Does the insurance company even show a coverage / benefits check from this provider a few days before the scheduled procedure?

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Rick Hahn is the best GM in baseball.

this is why i love my obamacare. i just call the irs and tell them to fuck off and i dont have to pay shit

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the world will always the world. your entire existence is defined by your response.

Ah the perks of being an unemployable pied of shit.

pied of shit? also, i had obamacare when i was employed, cocklover

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the world will always the world. your entire existence is defined by your response.

Don't put up with that shit Ike.

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Aetna....they actually paid their portion. They didn't receive it until 14 months after the fact.

it's now in collections, so I'm not sure what to do, but I don't feel I should have to pay. I'd never to a job and show up 14 months later with an invoice for the first time.

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Hmm...if Aetna received and paid the claim, you would have received an EOB. This would have notified you that a bill was likely coming. Also, it is fairly easy for provider billing departments and outsourced billing offices to 'prove' they've attempted to contact you with the amount you owed.

You might be SOL on this one.

However, even if it is a "bad debt 1" level collections (nothing reported against you yet, all talk but nothing to back it up) they'd likely settle for 50%. Tell them you'll pay $250 to settle it, and negotiate from there. Again...may take a few phone calls. They'll threaten to put it against your credit, but medical bills are removed from credit reports once paid, and do not leave a lasting mark once paid.

(Each provider usually has a couple of agencies working with them. What starts as a bad debt 1 with one agency will be transferred to another agency upon reaching bad debt 2 [outstanding for xx amount of months longer]. When a debt is transferred after that agreed upon time frame, the first agency would no longer get their commission. So they have a desire to settle the debts before they are transferred out.)

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Rick Hahn is the best GM in baseball.

And now you're not employed...because you were fired....again. Weren't you supposed to be sucking dick for drugs in L.A. by now or did you fuck that up too?

Maybe next time, Ike.

figure out their appeal process and get going with it.

Just write it off.

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Tell them you paid You have a cancelled check. Number 1329. Get all huffy about it.

If it took them this long to bill you, they must be all screwed up and wont know the difference.

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Patients tried this all the time. Never worked.

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Rick Hahn is the best GM in baseball.

just because your dogs wont lick your balls anymore doesnt mean you have to be mean to people

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the world will always the world. your entire existence is defined by your response.

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Good people drink good beer - Hunter S. Thompson

<º)))><

Waiting for the time when I can finally say
That this has all been wonderful, but now I'm on my way

This is correct.

someguy prefers extra nutty kind

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the world will always the world. your entire existence is defined by your response.

Crunchy is awesome.

Give it to me hard and thick!

you would you gay ass beastiality fuck

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the world will always the world. your entire existence is defined by your response.

More violent homophobia from Ike.

Say it ain't so!

Ill fuck u in the ass homo

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the world will always the world. your entire existence is defined by your response.

IMU...or anyone else,

I told the collection firm I wanted to dispute the bill. I also said I would settle it for $300 (current balance states $786.40). We had not heard anything for quite a bit so called the collection firm back for an update. They said since it's in dispute, it goes back to the medial provider and the effort to collect is on hold. Interesting.

Question is....do I just sit on this or wait to hear from the medical provider?

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I would follow up with the medical provider / collection agency every couple of weeks. No need to call daily. The collections effort was put on hold (and I'm assuming, not even reported against you yet) so until you hear back from them, you should do okay. But following up never hurts.

Providers are hit and miss at researching unpaid insurance claims. Depends on which billing lady (or man) was assigned your bill, and how much they like their job. If they come back and say it is taken care of, you'll want to call your insurance to confirm. If they state the insurance is still not paying, all is not lost. You just need more details and to further discuss it with your insurance company.

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Rick Hahn is the best GM in baseball.