a community of practitioners

Am I SOL with the Statute of Limitaitons?

Happy Saturday (aka) Dump your bank day,

I just ran into an insurance billing problem that I haven't encountered before. I was treating a doctor's patient after a motor vehicle accident that happened last October 2010. Well, low and behold, GEICO has a one year limit on paying out claims. I was informed of this by phone, a week after billing for visits in October 2011 and I have four visits I may not get paid for. The patient does not have an attorney and I'm wondering if there is any way to get paid by her insurance company.

Does any one in California have any suggestions?

I would appreciate it.

Cheers,

▶ Reply to This

Replies to This Discussion

Permalink Reply by Daniel Cohen on November 5, 2011 at 10:30am

You submit to their insurance company. If it is their insurer paying because it was their fault they can pay until the case closes. If someone else was at fault then it goes in with their insurance claim and may take longer. Is GEICO the clients insurance? Was it their fault? If there was no attorney the case may have closed already, but try filing. If you don't file you definitely don't get anything.

▶ Reply

Permalink Reply by Pete L Blanco II on March 22, 2012 at 12:32am

I know I'm late chiming in here...but, I'll throw my 2 cents in anyway. Assuming GEICO is the MedPay coverage, I would bill them anyway, if only to get their denial in writing for the file. I would concurrently advise the patient that their insurance is denying payment and that the balance due is now the patient's responsibility to pay. The patient might be able to put some pressure on GEICO to get them to pay you despite their 1-year limitation.

Regardless of insurance coverage, the bill is ultimately the patient's responsibility. Without an attorney on record, I would not accept a lien against the settlement. If the client is unable to pay the balance in full in a lump sum, I would establish a payment arrangement IN WRITING with the patient. Payments of perhaps 20% of the balance per month until paid off. (Negotiate with them something they can afford to do that works for you as well.) I'm assuming the balance due in this case is approx. $400 so that would be approx $80/month for 5 months. I would offer the patient the convenience of doing automatic payments whereas you would have their credit card # on file and would process the payment automatically on whichever day of the month you agree to. (This saves you the headache of having to call them should they forget to send you a check.)

▶ Reply

Permalink Reply by Gordon J. Wallis on March 22, 2012 at 1:09am

I haven't read the other replies...If you are making a living billing insurance companies. Don't expect to get paid for all your work. Trust me.. I solely billed insurance companies for ten years. Work comp. and Auto....dealt with all the insurance companies. You will not get paid for all your work...I didn't,, that's for sure. Overall I did ok.. so not really complaining. I made an ok living....But I had to spend a fair amount of time trying to get my money from insurance companies...It was a pain in the butt sometimes.. They have developed an art-form for denial of payment. Did I say that right?

▶ Reply

Permalink Reply by Jody C. Hutchinson on March 22, 2012 at 8:28am

After contacting GEICO and the other insurance company, I got nowhere. The patient paid a reduced rate for the four visits over four months and that was good. I realize that it had been a couple of years since I had worked a PI case, so I need to be a little more mindful. I agree that insurance is a hard way to make a living, yet sometimes it does pay.