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Insurance company waiting on Medicare Billing for over 9 months


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#1 birdmomdad

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Posted 13 February 2013 - 12:13 AM

I fell down unlighted mail box steps at my apartment complex in November 2010. I live in south Carolina. The insurance company for the property was mailed a demand letter with the hospital bills for the injury. My attorney sent in pictures of the broken light and crumbling steps. And picture of me with my stitches and black eye.

My attorney started this process after my fall. We are waiting now for the Medicare bill to be mailed to the property insurance company. I signed a waiver and it was mailed to Medicare by my attorney. We were told to wait until the bills were in the insurance company hands. I checked on December 24, 2012, nothing yet was mailed by Medicare.

Three years is the statute limit in SC. Does Medicare take so long to mail a bill? And if the insurance company does not get the medicare bill by November 2013, will the statute be over? I am waiting on getting some compensation for the injury. The Insurance company wanted to see the actual medicare payment. And compare the diagnosis and treatment for my injury with the bill. But the hospital bills show that. Is this too long and should I wait longer or find some other attorney?

#2 adjusterjack

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Posted 13 February 2013 - 10:32 AM

The statute of limitations has nothing to do with filing your claim or negotiating a settlement.

It has only to do with the deadline for filing a lawsuit.

If you don't file a lawsuit by the November 2013 deadline the insurance company can just thumb it's nose after the deadline and pay you nothing.

I don't see where your lawyer is doing anything wrong. He's stuck in the middle and isn't likely to be able to get Medicare moving any faster. And if the insurance company is just stalling, he still has time to file a lawsuit before the deadline.

I suggest you discuss that with him and ask him what he will do about that and when.

You might also read SC statute 38-59-20 Improper Claims Practices

http://law.justia.co...le38/chapter59/

And discuss with your attorney the possibility that the insurance company is engaging in improper claims practices. Probably a stretch at this point but something to consider in case it gets egregious.

One other thing. Can you not get the billing summary from the Medicare website?

https://www.mymedicare.gov/

Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.


#3 birdmomdad

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Posted 14 February 2013 - 12:47 AM

The Insurance company wanted to see the paid itemized bill that Medicare sent to the hospital. I did not know about the web site at Medicare showing that. I thought it was something that had to have the hard copy mailed to the insurance company.

As far as my lawyer, I understand that he is just waiting on the insurance company. It is just that it is a long process and I thought there might be a problem with this. Thank you I will contact my lawyer with these suggestions.

#4 birdmomdad

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Posted 02 March 2013 - 09:04 PM

We did what you suggested. I have contacted my lawyer, and there has been nothing new, nor any response from the Apartment complex insurance company. I am waiting now for almost 3 years on this accident claim. It is getting to be long for me and I wonder if I should wait. .

#5 adjusterjack

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Posted 02 March 2013 - 10:46 PM

We did what you suggested. I have contacted my lawyer, and there has been nothing new, nor any response from the Apartment complex insurance company. I am waiting now for almost 3 years on this accident claim. It is getting to be long for me and I wonder if I should wait. .


Did you ask your lawyer about filing the lawsuit?

Once a lawsuit is filed, the insurance company has to start paying its own lawyer and his fees can start running up pretty quick. That could give the insurance company the incentive to move things along. Litigation also brings the claim to the attention of upper management who always want to know why it came to litigation. That puts the claim rep on the hot seat with corpies looking over his shoulder.

Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.





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