Who is responsible for a mistake with health insurance billing?

If a healthcare provider fails to file an insurance claim on your behalf, files it incorrectly, or fails to pursue a denial, who is on the hook?  It turns out you are, dear unsuspecting patient.

Patients worry that insurance claims aren't being filed properly

It's fairly common for patients to fear becoming responsible for huge medical bills because of mistakes made by others.  In particular, they worry their healthcare provider will screw up the insurance claim, or the insurer will refuse to pay it:

• Reddit user melonchollyrain asks, "Will I be on the hook for thousands since [my provider] didn't file [valid claims with my insurance]? What if they filed wrong?"
• Reddit user theophilus1988 asks, "I got a procedure done for an endoscopy almost a year ago today and I still haven't received a bill in the mail yet. ... Should I be concerned and what's going on?"
• Reddit user QuicaDeek says, "I’m being charged $8800 because my doctors never sent pre-certifications".

The answer is rather shocking.  As discovered by Reddit users like bobbyo23 and Spectrachic311311, providers can and will circle back years later to collect payment – even if they failed to collect it because of their own mistake.

Is it legal for a provider to bill you years later?

Yes, it's generally legal for a healthcare provider to send you a legitimate bill even if they do it years later.  They would argue they provided service and deserve to get paid.  They might even argue you should thank them for not charging interest!  Regardless, it's legal for them to send a legitimate bill in hopes that you will pay.  The question is whether the bill is legally enforceable.

Is a bill legally enforceable years later?

Bills are not legally enforceable forever.  How long a debt remains valid, especially if there is no attempt to collect it, is a legal question.  The answer varies between 3 years and 15 years, depending on the "statute of limitation" laws in your jurisdiction.

To learn about the statute of limitations in your state, visit the BetterCreditBlog post about medical debt and scroll down to "Statutes of Limitations for Each State".  Keep in mind that laws can change over time, so you might want to do your own Google search to confirm what you find.

For most people, their medical bills are still legally enforceable even if sent a year or two late. So don't ignore them, because most healthcare providers don't hesitate to send bills to collections agencies.  And as soon as a collections agency gets your bill, your credit score will take a hit.

You are responsible

Patients are responsible for making sure their healthcare providers get paid, not anyone else.

Yes, it might seem like a patient's health insurer should be responsible. And in specific, contractually-specified circumstances, they are.  But even in those circumstances they may not pay due to a mistake of their own, or a mistake of the healthcare provider's.  This is what seems unfair – when other people make mistakes with a process the patient isn't involved in, somehow the patient is responsible.  But that is the practical reality.

The fact that patients are ultimately responsible for mistakes made by others leads many patients to pay out of pocket, and avoid the risk.  If you're considering paying out of pocket for healthcare, you should look into Pocketero.  It empowers you with the best prices when paying out of pocket.