What laws are relevant to a hospital that failed to bill my insurer within a timely manner?

James: What laws are relevant to a hospital that failed to bill my insurer within a timely manner?
My insurer has a 95-day limitation on debts. The hospital did not get the bill to them in that amount of time. Now the hospital wants me to pay them since the insurer won’t, even though it’s the hospital’s fault. What laws (or ideas) can I reference to the hospital’s bill collector? I don’t believe that I should be liable for payment.

P.S. This is in Texas.

Answers and Views:

Answer by Truth B
The hospital should eat the entire bill. They must submit a bill for payment not later than the 95th day after the date on which the health care services were provided. Failure to timely submit a bill constitutes a forfeiture of right to reimbursement. This link is to some TX case law that I hope helps you out.

Answer by jslinderml
I actually couldn’t find a law directly on point skimming over TX statutes. The underlying issue seems to be why the bill was not delivered in a timely manner.

For example, the process may be different if the hospital issued a bill on day 45, but it was never received, versus if the hospital sent the first bill on day 100 (not common in the industry I assure you). Assuming the hospital is familiar with your insurer and their policies, they should have handled the matter.

What you probably need to do next is get a full accounting from the hospital as to what invoices were sent to whom when. Based on that, its possible this may end up in court, where you and/or your insurer sue the hospital.

Other thoughts? How far past the 95 day limit were they? If only a few days, I would consider appealing the insurers decision, especially if you have proof external factors delayed the bill.

Answer by Artman
There is no an specific law, BUT you can try to sue them for negligence; but you would need to prove they knew about this 95-days deadline and that you took “diligent” steps (call, visits, letters) to make sure they did it on time.

If you took no actions during those 95 days then it might look bad for you.

Can you win? There are never warranties about that.