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Provider filed claim 'late'


I had Unitedhealthcare at the time of a hospital stay.  I received a bill for the amount of the stay.  Upon
receipt of the bill I called the insurance company and they stated that the provider sent the claim in late,
and are therefore not responsible for payment.
What is my next step towards resolution?  Is this a common practice and am I responsible.  I want to know my rights.

Thank you,
2 Responses
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282113 tn?1388159749
Dear Heather197,

A few things play a role in how you would approach this issue;

- Was your hospital stay an emergency or a pre-planned routine admission?
- Was pre-authorization required and obtained for your stay?
- Did you or the hospital inform your insurance carrier that you were admitted?
- How late was your claim sent to your carrier?
- Is the hospital contracted with your insurance carrier?

But overall if your hospital is a preferred provider with your insurance carrier, they should have signed a contract with your carrier that spells out the guidelines agreed upon by both parties. So your next step is to ask your carrier to help you by providing those guidelines to you so you can base your argument on the fact that your hospital has made a mistake & you shouldn’t have to pay for their mistake even though they may have had you sign a document saying it is eventually your responsibility to ensure the hospital gets paid.


Amir Mostafaie

Helpful - 1
Avatar universal
Thank you so much for your feedback.  
My stay was for a birth and I did call my insurance carrier prior to my stay.
I did not need a prior auth. etc...
I will contact the insurance for the info.

Thanks again,
Helpful - 0

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