Question 

My mother died a year ago and I am charged with the responsibility of paying her bills and settling the estate. She has some money remaining for her heirs but not a lot. 

A few days ago, I received a bill from the doctor’s visit that she had the day before she died. It is not for very much money, though I am planning to ignore it. How on earth can they send out a bill a year after someone died! I think that this is ridiculous. 

That doctor can just forget about being paid. After all, my mother has been dead for a year. It is time for them to just write it off. 

What is wrong with health care? 

Answer 

That is a very good question and the answer, like healthcare, is not simple. 

There was a time when you went to the doctor, paid your $15 and went home. That was likely before World War II when almost no one had health insurance that covered doctor visits. You received a service, and you paid the bill before you left, simple. Health insurance was not a factor and two or possibly more parties liable for one bill was unheard of. 

Today, almost everyone has insurance or should have it. Clinics, hospitals, or individual doctors must bill your insurance and then wait for a response before billing you what remains. Most providers bill daily, weekly, or monthly at a minimum. Once the bill is sent or transmitted, the provider waits. It can take months to get a response. 

I am guessing that your mother was a Medicare recipient. If she had Medicare and a supplement that means that the provider had to submit two claims, one to Medicare and a second to the supplemental insurer. Outpatient services are covered by both Medicare and the supplement if she has traditional Medicare. Oftentimes you bill Medicare, wait for a response and then bill the supplemental for the remainder. In the meantime, the patient is not sure what the outcome will be. 

Any little thing can delay payment on a claim, like a code, missing line, or the claim being pulled for review. At times a claim can sit in suspension for months. It is not unusual for a provider to have hundreds of claims that are not paid timely by an insurance company or Medicare, that require follow up and resubmission. Providers employ people to do nothing but submit claims, process payments, resubmit claims, file appeals on your behalf, and more. Sometimes entire departments of staff attempt to collect payment. 

Providers generally do not demand payment until Medicare and the insurance company settles the claim. Most will send you statements along the way indicating that the claim has not yet been paid. 

Therefore, getting a final bill from a health care provider months after a visit is not that unusual. It is disturbing when it happens because in other aspects of our lives, we receive a service and pay for it on the final day. Oh, how I wish health care was that simple. When you complicate services with fancy coding, multiple payers, and much scrutiny, you get what you experienced. 

Next, let's talk about your approach of denying payment to that doctor. You may or may not get away with that approach, but should you? Assuming that they simply did not bill for a year is likely false. All insurers have billing deadlines that providers of care must follow. Someone has spent a year trying to get your mother’s claim paid. That’s a lot of work for very little money. They finely collect all they can and send the remainder to you. 

Either way, I suggest you just take the money from your mother’s estate and pay the bill. You see if you do not pay, all of the other patients pay just a little bit more to cover your bill. That one to fifty percent that do not pay will be covered by other patients paying more, much like shoplifting requires stores to charge more to paying customers. When the day is done, they have to pay their employees and all of their other bills, and wind up in the black at the end of the year to stay in business and continue seeing patients. 

Lastly, there are estate laws that govern how the assets of the estate are assigned, managed, and distributed. Assuming that you are the executor of the estate, I recommend that you consult the estate attorney before making a decision not to pay a bill because you are annoyed. There are regulations about such things that need to be considered. Failure to do so could make the liability yours. 

It is a lot of work to pay all of the bills, clear out the possessions, provide all of the notices, and distribute the assets of an estate. If you were selected to be the executor, your mother believed that you had the stamina to handle it. You can get through it on her behalf.