Search the Community

I see this come up a lot with medical collections, and other states may have a similar statue in place. This is probably already posted somewhere on CB, but I just ran across a Texas law that indicates a patient cannot be billed if the provider fails to file a claim with their insurance provider in accordance with said law. (See last subsection, § 146.003. Certain Claims Barred) Tex. Civ. Prac. & Rem. Code § 146.001 (2000) § 146.001. Definitions In this chapter: (1) "Health benefit plan" means a plan or arrangement under which medical or surgical expenses are paid for or reimbursed or health care services are arranged for or provided. The term includes: (A) an individual, group, blanket, or franchise insurance policy, insurance agreement, or group hospital service contract; (b ) an evidence of coverage or group subscriber contract issued by a health maintenance organization or an approved nonprofit health corporation; (C ) a benefit plan provided by a multiple employer welfare arrangement or another analogous benefit arrangement; (D) a workers' compensation insurance policy; or (E) a motor vehicle insurance policy, to the extent the policy provides personal injury protection or medical payments coverage. (2) "Health care service provider" means a person who, under a license or other grant of authority issued by this state, provides health care services the costs of which may be paid for or reimbursed under a health benefit plan. § 146.002. Timely Billing Required (a) Except as provided by Subsection (b ) or ©, a health care service provider shall bill a patient or other responsible person for services provided to the patient not later than the first day of the 11th month after the date the services are provided. (b ) If the health care service provider is required or authorized to directly bill the issuer of a health benefit plan for services provided to a patient, the health care service provider shall bill the issuer of the plan not later than: (1) the date required under any contract between the health care service provider and the issuer of the health benefit plan; or (2) if there is no contract between the health care service provider and the issuer of the health benefit plan, the first day of the 11th month after the date the services are provided. (c ) If the health care service provider is required or authorized to directly bill a third party payor operating under federal or state law, including Medicare and the state Medicaid program, the health care service provider shall bill the third party payor not later than: (1) the date required under any contract between the health care service provider and the third party payor or the date required by federal regulation or state rule, as applicable; or (2) if there is no contract between the health care service provider and the third party payor and there is no applicable federal regulation or state rule, the first day of the 11th month after the date the services are provided. (d) For purposes of this section, the date of billing is the date on which the health care service provider's bill is: (1) mailed to the patient or responsible person, postage prepaid, at the address of the patient or responsible person as shown on the health care service provider's records; or (2) mailed or otherwise submitted to the issuer of the health benefit plan or third party payor as required by the health benefit plan or third party payor. § 146.003. Certain Claims Barred (a) A health care service provider who violates Section 146.002 may not recover from the patient any amount that the patient would have been entitled to receive as payment or reimbursement under a health benefit plan or that the patient would not otherwise have been obligated to pay had the provider complied with Section 146.002. (b ) If recovery from a patient is barred under this section, the health care service provider may not recover from any other individual who, because of a family or other personal relationship with the patient, would otherwise be responsible for the debt.

I apologize if this has been brought up before, but I recently learned about this consumer agency that contains medical records on people for insurance underwriters. As I'm shopping around for Health Insurance, this agency's name came up. I also discovered that you can get a free copy of your file once per year at www.mib.com. I requested my copy this weekend, although it's my understanding that the cryptic coding they employ may make it unreadable to me. I feel as though they (health insurance companies) want you to put down as much information as possible, so they can charge you higher premiums. Well, I don't want to give them any more money than I have to.. but I also don't want to be denied coverage. Does anyone have any experience dealing with this agency? Here's a little background information on the MIB: Most consumers are well aware of credit reporting agencies. They keep track of how well we pay our bills and manage our credit so lenders can decide whether to loan us the money we need for mortgages, car loans, credit cards and other credit devices. But most consumer-patients are surprised to learn of the existence of a parallel reporting agency for the health industry, the Medical Information Bureau (MIB) . Originally established in 1902, it serves the information needs of almost 500 health and life insurance companies in North America that seek health, credit and other information about those consumer-patients who request to be insured. The purpose behind the MIB is to provide background information to its insurance company members so they can determine who they will accept for insurance, or who they will reject. According to the MIB, they collect information on only 15 to 20 percent of people who have applied for individual health or life insurance policies. The MIB states its mission as "detecting and deterring fraud that may occur in the course of obtaining life, health, disability income, critical illness, and long-term care insurance." Those savings, the MIB claims, help to lower premiums to insurance-buying consumers. Considered by the government to be a consumer reporting agency, its services must adhere to the US Fair Credit Reporting Act and the Fair and Accurate Credit Transactions Act. For consumer-patients, this means it must follow the same disclosure rules as the credit reporting agencies we are more familiar with. That means you are able to obtain copies of any reports they hold on you, and there is a procedure for disputing errors. What Information does the MIB Collect?Credit information Medical conditions Medical tests and results Habits such as smoking, overeating, gambling, drugs Hazardous avocations and hobbies Motor vehicle reports (poor driving history and accidents) The information collected by the MIB stays on file for seven years. If any of its members have requested your file in the previous 12 months, that will be listed with your records. Why Do MIB Members Need this Information?The reason this information is collected is specifically to help its member companies make decisions about who will live a long and healthy life. Life, disability, long-term care insurance and other health-related companies are only interested in insuring people who will outlive the company's need to pay them. Their interest is in making money, so they want to insure only those people who will pay premiums that over the long term will eventually add up to more than the insurance company has to pay out on their behalf. The information collected by the MIB helps the insurance companies decide which applicants will likely live long enough to help the company make its profits. Who Has Access to MIB Collected Information?Employees of its members may access your personal information to help them in their underwriting decision-making. In order to gain access, they must get your signature. You have access to your MIB report once each year at no cost to you. You must call the MIB at (866) 692-6901 (TTY (866) 346-3642 for hearing impaired. The MIB states specifically that "Employers, vendors, and non-Members do not have access to MIB files." Why is This Important to Patients?Like other medical records, patients need to be aware this organization exists to influence their ability to obtain the insurance they may wish to acquire. If you think you will be purchasing any form of life, disability, long-term or other health-related insurance within the next few years, plan to obtain any MIB records currently on file in order to review them for accuracy.