Ameriben unpaid claim

I recently received a call from a collection agency about a hospital bill from 2009.  Back then we had as the 'only' insurance Ameriben (PHCS), I called to asked them why they didn't pay and they told me the claim is too old and after asking for a reason they placed me on hold and told me that back in October 2009 (service was rendered on 7/7/2009) they sent me a letter requesting confirmation that we didn't have another insurance, and because they didn't received that letter back, the claim was pended and now after 2 years there is nothing they can do.  My husband who was the patient was not working for close to a year already back then so therefore we didn't have insurance other than mine.  I asked Ameriben if they have a signature where I received the letter and they said no, they mail it regular mail on a regular envelope, I told them if is so important, why not send a letter certified to make sure people receive and acknowledge the letter, Mandy the CSR said we don't do certified letters.  The total amount of the claim is $7,223.95, I can possibly pay this to the collection agency or the hospital for that matter.  Any true to what they said about the claim? any suggestion you can provide will be greatly appreciated, I am concern about this unpaid claim. Thank you

[Amir Mostafaie]

Dear member,

Although I always advise people to take it upon themselves to make sure their claims are paid (with documentation to prove it), the average person understandably doesn’t worry about bills they’ve never seen.

It’s true that most insurers have a deadline for receiving/paying claims (apparently 24 months in your case). It’s also true that insurers will sometimes send letters to members to make sure that a claim is valid or that there’s no other insurance company that should process the claim first. This kind of thing can delay the paying of a claim, but it’s generally incumbent on the insurer to make several good-faith attempts to contact you, by letter or telephone. It is unfortunate that the hospital did not inform you within the 24-month time period your insurance company requires, and that your insurer apparently didn’t follow up on their initial inquiry. That said, if the insurer is not willing to work with you, you may have a couple avenues of recourse:

• You always have the right to contact the office of the insurance commissioner or the state Department of Insurance about your situation. This would be mainly to deal with the insurance company.
• You also have the right to seek legal action against the hospital for not attempting to inform you about the outstanding claim in a timely manner.

Best wishes.

Amir Mostafaie