How Long Does a Medical Provider Have to Bill You in the U.S.?


Medical Provider

The billing process in the health care industry is quite different from the billing process we all know. Normally, after purchasing an item in a mall or benefiting from the services of a professional, you are required to pay instantly. However, that is not how things work in the health care industry, especially if you have insurance. After receiving healthcare services from a medical provider, you will be billed according to the services provided. Medical providers are required to submit the bill within a period. What is the duration?

The time provided for a medical provider to bill you in the U.S. depends on a few factors, such as the processing time of the insurance company and the doctor’s office. However, you should expect a bill in a month (if you lack insurance) and within 1-15 months if you have insurance.

There are many instances of individuals who receive medical bills after a year or two. While such occurrences can be baffling, you must understand that it has become a norm in the health care industry, especially with medically insured individuals. The delayed bill submission is due to some checks and reconciling done by medical providers and insurance companies.

These checks are designed to answer questions like:

  • Have you met your deductibles?
  • How much you paid when you were there?
  • Was the charge properly coded?

In this article, I’ll explain the medical billing time limits and other related topics.

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How Long Does a Medical Provider Have to Bill You in the U.S.?

It is a norm to purchase a product, receive a bill for the purchased product and make instant payment. The same applies to services rendered by an artesian or a professional like a lawyer. However, as said earlier, things are quite different when it comes to the healthcare industry. After visiting a doctor and receiving medical services, you are billed for the service rendered. However, this doesn’t happen instantly, especially if you have insurance.

How are you billed?

If you have insurance and visit a hospital for treatment, you aren’t required to pay a dime, at least not yet. The medical provider prepares a bill, then goes ahead and submits a claim to your insurance company to receive payment. In turn, your insurance company will send you an EOB to inform you of the claim tendered by the medical provider, how much is being covered by the company, and how much you owe.

Several insurance companies, like Blue Cross Blue Shield, will have sample EOBs on their sites. Taking a good look at them is a good way to understand what EOBs looks like including the information on them.

After receiving your bill from the medical provider the insurance company will settle a percentage of it, and you’ll be required to settle the balance. Note this: your medical provider wouldn’t send you a bill until your insurance company has paid its part. Thus, the time required for you to receive a bill depends on the processing time of your insurance company coupled with other factors.

That said, don’t be perplexed when a friend tells you that he just got billed a medical appointment he made two years ago. Instead, to ensure you don’t get shocked by any medical bill from the past, you need to ask yourself, “How long does a medical provider have to bill you?”

The medical billing time limit in the United States:

After treating a patient with medical insurance or offering any medical service, medical providers are required patient claims to the patient’s insurance company. It is the job of this company to pay a portion of the patient’s bill.

There is often a medical billing time limit set by each insurance company when it comes to submitting claims. That said, you may want to ask, “What is the time limit to submit a health insurance claim?”

The medical billing time limit usually differs per insurance company.

Below is the time limit of some insurance companies in the U.S.

Healthcare InsuranceTimely Filing Limit
Aetna120 days from the date of service
Humana180 days (physicians), 90 days (ancillary providers)
Medicare12 months from the date of service
Tricare12 months from the date of service
United Healthcare90 days from the date of service
Kaiser Permanente12 months after the date of service
Medical Mutual12 months from the date of service
Emblem Health365 days (in-network), 18 months (out-of-network)
Source

If you want to find out the medical billing time limit of your insurance company, you can easily do that by checking the company’s manuals. Health insurance companies always publish comprehensive manuals (Also regarded as provider manuals) that contain information concerning their claim submission and reimbursement processes.

Having said that, let’s revisit the crux of this article: how long does a medical provider have to bill you?

The status of limitation for medical debts is 6 years. This simply means that medical providers have six years (from the day the medical service was rendered) to collect any outstanding debt. So if a medical provider fails to bill you during this duration (6 years), the provider will be unable to sue you if you decide not to pay the debt.

However, expect most medical providers to bill you before the limitation expire. Some may bill you within a month to 15 months after the date of your medical appointment.

Note: it is important to note that the statute of limitations for medical debts is different in each state. So don’t assume that it’s 6 years in the state you reside in.

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Can a Hospital Bill You 2 Years After?

Medical providers don’t bill individuals with insurance directly. Thus, if you have medical insurance, the medical provider will draft your bill and file a claim to your insurance company requesting payment for the medical services rendered to you. The company will pay a portion of the bill and leave the rest to you. Mind you; the medical provider cannot bill you until it has received payment from your insurance company. That said you may want to know, how long does a hospital have to bill you for medical services? Can the hospital bill you if it takes two years for the insurance company to make payment?

A hospital can bill you after two years or even more than (6 years is the max after which they cannot sue for the debt). If you are billed after two years, it is probably because the hospital filed a claim late or the insurance company made a payment late.

All medical insurance companies have different policies. So ensure you understand how your insurance company works to have an insight into when you’ll receive your bill.

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