Timely Filing and COB
How does timely filing apply to the following situation?
1.) Provider sends $35k claim to primary insurance (Out of network) for service dated 6/23/2021
2.) Primary Insurance finally pays all but deductible ($3K) on 9/17/2021
3.) Secondary Insurance (In network) gets claim on 11/21 and says Primary paid more than their in network rate ($19K) so nothing more is owed.
4.) Primary insurance comes back on 4/4/22 and denies the original claim saying it should have been billed as out patient .
5.) Primary insurance finally decides to pay around $19k on 5/24/2022 and lists it as Urgent Care. Says we owe the ($3k) deductible.
6.) Secondary insurance has yet to receive the revised claim from May 2022. It’s well over 1 year since the date of service. Am I going to get screwed and have to pay the deductible (We met our yearly max out of pocket with our secondary)? Note that I have never received a bill from the hospital so there is nothing I can even do to send it to the secondary.