A bill from a hospital visit you had last winter. A statement from an anesthesiologist you never met, for a surgery that was fourteen months ago. A radiology charge for a scan your insurer already paid for. The question is always the same: can they still do this?
Usually, yes. But "can they bill you" and "do you have to pay it" are two different questions, and the second one has a better answer than most people expect. Whether a late bill is yours to pay depends on who was supposed to be billed first, and whether the provider met that deadline.
Quick answer
How long a hospital or doctor has to bill you
Start with the uncomfortable part. Nothing in federal law says a provider has to send you a bill within 30 days, or 90, or a year. Sixteen months after an ER visit is legal in most of the country. Two years is legal. The only thing that eventually stops them is the statute of limitations on medical debt, which is a limit on suing you, not on mailing you a statement, and it runs three to six years in most states.
So if you go looking online for "medical billing time limits by state," treat what you find with suspicion. Most of those lists mix up three different clocks: how long a provider has to bill your insurer, how long a provider has to bill you, and how long a provider has to sue you. Only one state has written the middle one into law.
The good news is that the first clock, the one between the provider and your insurer, is short, strict, and works in your favor.
Everything above is the general version. For $49, a mediloop specialist reviews your bill and EOB, if available, checks the charges and available pricing, and prepares a step-by-step Personalized Action Plan for that case. It appears in your account within 24 hours after all required documents arrive.
Get the plan for your billThe three clocks that actually matter
Your insurer's filing deadline
Every insurance contract sets a "timely filing limit," the number of days a provider has to submit a claim after treating you. Miss it and the insurer denies the claim with a code you will see on the explanation of benefits: CO-29, "the time limit for filing has expired."
Here is what that means for you. When a provider is in your plan's network, they have signed a contract agreeing to file claims on time and to write off anything the insurer refuses for lateness. They cannot pass that loss to you. EmblemHealth's provider policy puts it plainly: "Participating practitioners may not bill the patient for services that EmblemHealth has denied because of late submission." Other insurers use different wording, but the rule is standard in network contracts.
| Who pays | How long the provider has to file the claim |
|---|---|
| Medicare | 12 months from the date of service, set by federal regulation |
| Medicaid | 12 months from the date of service, the federal maximum; some states set shorter limits |
| Commercial plans | Set by each plan's provider contract, commonly 90 to 180 days in network. EmblemHealth, for example, gives participating providers 120 days and out-of-network providers up to 18 months |
Two caveats. Out-of-network providers have not signed your plan's contract, so a timely filing denial does not protect you from them in the same way. And plans usually give members a longer window to file a claim themselves than they give providers, so if a provider tells you they "missed the deadline," ask your insurer whether you can still submit it yourself before you agree to pay anything.
Medicare's 12-month rule
Medicare is the clearest case. Federal regulation requires claims to be filed within one calendar year of the date of service, and Medicare denies later claims with almost no exceptions. Providers are also legally required to file the claim for you; they cannot charge you for doing it, and a provider who accepts assignment agrees to bill you only the Medicare deductible and coinsurance.
NPR reported a case that shows how this plays out. Thomas Greene, 74, had bypass surgery on his leg in Pennsylvania in April 2021. The anesthesia group did not file its claim with Medicare until September 2022, seventeen months later. Medicare denied it, and the group sent Mr. Greene a $2,965.58 bill and then sent it to collections. The director of the Center for Medicare told NPR: "If a Medicare provider sends a claim a year or more after a service is provided, it is denied except in very rare circumstances. There is no exception for provider error." The company dropped the collection effort after he pushed back with help from an advocacy group, and he never paid.
If you are on Medicare and a late bill arrives, find the Medicare Summary Notice for that date of service. If it shows the claim was denied for late filing and your responsibility is $0, that notice is your defense.
Medicaid: also 12 months
Federal rules require every state Medicaid agency to make providers submit claims within 12 months of the date of service. Some states set shorter limits. As with Medicare, a provider who treated you as a Medicaid patient and missed the deadline cannot usually turn around and bill you instead.
Texas: the only state with a real deadline
Texas Civil Practice and Remedies Code section 146.002 requires a provider to bill you "not later than the first day of the 11th month after the date the services are provided." In practice that is a little over ten months. If the provider is supposed to bill your health plan first, the deadline for that claim is whatever their contract with the plan says, or the same eleven-month date if there is no contract.
Miss it, and section 146.003 bars the provider from recovering "any amount that the patient would have been entitled to receive as payment or reimbursement under a health benefit plan." Notice what that does and does not do. If you were insured, a late Texas bill loses the part your plan would have covered, and the provider cannot chase a family member for it either. It does not automatically erase what you would have owed anyway, like your deductible, and it gives an uninsured patient less to work with.
No other state has a matching statute that we could verify. Virginia's medical debt law, for example, sets a 120-day waiting period before a provider can take "extraordinary" collection action after the final invoice is due, but it says nothing about when the first invoice has to arrive. If you have seen a claim that California or Florida or New York sets a one-year billing limit, ask for the statute number. There is not one.
Why bills show up months or years later
Late bills are rarely a sign that something illegal happened. They are usually a sign of how many hands touch one hospital visit.
The most common reason is that insurance took its time. The provider filed within the deadline, the insurer processed the claim, maybe denied it, maybe reprocessed it after an appeal, and only then did the provider bill you for whatever was left. That chain can take six months without anyone breaking a rule.
The second is that the hospital is not the only party who treated you. The emergency physician group, the radiologist who read your scan, the anesthesiologist, the pathology lab: each of them bills separately, on their own schedule, often through a billing company you have never heard of. A bill from a name you do not recognize is often one of these. It is also the kind of bill most worth checking against the No Surprises Act, because these are exactly the providers it covers.
Then there are the backlogs. Practices change billing vendors, move to a new records system, or get hit by an outage. When a cyberattack took down the Change Healthcare clearinghouse in February 2024, CMS said providers using it were prevented from submitting claims and receiving payment, and it set up emergency advance payments to keep them running. Every claim stuck in a backlog like that becomes a late bill for someone.
Finally, insurers sometimes take money back. A plan audits a claim it already paid, decides the patient was not eligible on that date or the service was coded wrong, and recoups the payment from the provider. The provider then bills you for the difference, sometimes a year or more after you thought the matter was closed.
None of these reasons change the deadlines above. They just explain why you should check which one applies before you pay.
Do you have to pay a medical bill from a year ago?
If the provider billed your insurer on time, the insurer processed it, and the balance is your deductible or coinsurance, then yes, the bill is real and the delay does not cancel it. Late is annoying. Late is not a defense on its own.
You may not owe it if any of these apply:
- The provider was in network and missed the timely filing deadline, and the insurer's denial says so. The provider has to write it off.
- You were on Medicare, the claim was filed more than 12 months after the service, and your Medicare Summary Notice shows a $0 patient responsibility.
- You were treated in Texas, insured, and the first bill arrived after the first day of the eleventh month.
- The bill is older than your state's statute of limitations. The debt still exists, but they cannot win a lawsuit to collect it. Read how the statute of limitations on medical debt works before you pay a cent, because a payment can restart the clock.
Whatever the answer, the bill cannot hurt your credit yet. The three credit bureaus wait a full year before an unpaid medical collection can appear on your report, and they do not report medical collections that started under $500 at all. Fifteen states go further and keep medical debt off credit reports entirely. The credit guide has the state list.
What to do when a late bill arrives
Do not pay it on the day it arrives, and do not throw it away. Both are how people lose money on late bills.
- Confirm it is real. A bill for a visit you barely remember, from a company you have never heard of, is a good target for scammers. Look up the provider's phone number yourself rather than using the one on the letter, and ask them to confirm the account number and date of service.
- Find the date of service and the insurance record. Log in to your insurer's portal, or pull the Medicare Summary Notice, for that date. There are three things you are looking for: whether a claim was filed, when it was filed, and what the denial or remark code says. If you see CO-29 or the words "timely filing," stop and go to the script below.
- Ask for an itemized bill. A late bill from a hospital is often a summary statement with one line. You are entitled to the itemized version with CPT codes, and the delay makes checking it more important, not less. Bills that sat in a queue for a year were not being reviewed by anyone.
- Compare the itemized bill to your EOB. The provider's charges, the insurer's allowed amount, and the patient responsibility line should agree. If the provider is billing you more than the EOB says you owe, that is balance billing, and in-network providers are not allowed to do it.
- Check the age of the bill against your state's statute of limitations if it is more than two or three years old. Do not make a payment, and do not acknowledge the debt in writing, until you have.
- Put your dispute in writing. Phone calls are fine for finding things out. The request to write off a timely filing denial goes on paper, by email or portal message, so there is a record. The dispute letter template works for this with a few changes.
What to say
On the phone with the provider's billing office, when the EOB shows a timely filing denial:
"I'm looking at my explanation of benefits for the date of service on this bill. The claim was denied by [insurer] because it was filed after the timely filing limit. You were in network with my plan on that date, so under your contract that denial is a provider write-off and cannot be billed to me. Please adjust the balance to zero and send me a written confirmation."
If they push back with "the insurance denied it, so it's your responsibility," ask them one question: "Denied for what reason?" Then ask them to read you the denial code. Most billing staff will see CO-29 and know exactly what it means.
In writing, keep it short:
To whom it may concern,
I am writing about account [number], date of service [date]. My insurer, [plan name], denied the claim for this service on [date on EOB] because it was not submitted within the plan's timely filing limit (remark code CO-29). [Provider name] was a participating provider with [plan] on the date of service. Under the terms of that participation agreement, a timely filing denial is a contractual write-off and the patient may not be billed for it. Please remove the balance of $[amount] from my account and confirm in writing within 30 days. If you believe the claim was submitted on time, please send me the claim submission date and the insurer's acknowledgement.
[Your name, address, phone]
For Medicare, swap the middle sentence for: "Medicare denied this claim because it was filed more than 12 months after the date of service. My Medicare Summary Notice for this service shows my responsibility as $0." Attach the notice.
If the bill is real and you cannot pay it
Sometimes you do the checking and the bill holds up. The provider filed on time, the insurer paid its share, and what is left is yours. The delay bought you nothing except a year of not knowing.
The options are the same as for any bill, and the guide to what to do when you can't pay covers them in order. Three are worth naming here because late bills trip a specific problem: a nonprofit hospital only has to accept financial assistance applications for 240 days after the first statement, and that clock starts from the first bill, not the date of care. So if you might qualify for hospital charity care, apply now, not after you have argued with billing for three months. If you are uninsured, ask for the self-pay discount before you agree to any amount. And if you need time, an interest-free payment plan is standard at almost every hospital, and a nonprofit hospital has to wait 120 days after that first statement before it can report you to a credit bureau, sell the debt or sue.
Common questions
Can a hospital bill you two years after treatment?
In most states, yes. There is no federal or state deadline for the first bill outside Texas. But if you had insurance at the time, the provider almost certainly missed the insurer's filing deadline, and an in-network provider cannot bill you for what the insurer would have paid. Check the EOB or Medicare Summary Notice before you pay.
How long does a doctor's office have to bill you?
The same rules apply to a doctor's office as to a hospital: no fixed deadline for billing you, but 90 to 180 days to bill most commercial insurers and 12 months to bill Medicare or Medicaid. A late bill from a physician group is usually one where the insurance claim went wrong.
Can a hospital bill you after your insurance already paid?
Yes, for your share (deductible, copay, coinsurance) and for anything the insurer legitimately denied. It cannot bill you for the difference between its charges and the insurer's allowed amount if it is in your network. That is balance billing, and the EOB is the document that shows whether it is happening.
What if I never got a bill and it went straight to collections?
Ask the collector for written validation of the debt, which you have the right to request, and ask the provider for the original itemized bill and the dates it was mailed. A nonprofit hospital has to give you written notice and wait at least 120 days after its first statement before any extraordinary collection action. Your rights when a medical bill is in collections walks through the steps.
Does a late medical bill affect my credit?
Not until it is at least a year delinquent, and not at all if the initial balance was under $500 or you live in one of the states that keep medical debt off credit reports.
Sources
- 42 CFR 424.44, Time limits for filing Medicare claims
For services furnished on or after 1 January 2010, a Medicare claim must be filed no later than the close of the period ending one calendar year after the date of service, with narrow exceptions for administrative error and retroactive entitlement.
- Medicare.gov, Does your provider accept Medicare as full payment?
A provider who accepts assignment agrees to charge you only the Medicare deductible and coinsurance, to usually wait for Medicare to pay before asking you to pay, and to submit your claim directly to Medicare without charging you for submitting it.
- Medicare.gov, Filing a claim
Medicare claims must be filed no later than 12 months after the date of service. If a claim has not been filed on your behalf, contact the provider and ask them to file it, and call 1-800-MEDICARE if they still do not.
- Noridian (Medicare Administrative Contractor), Mandatory claim submission
Section 1848(g)(4) of the Social Security Act requires physicians and suppliers to submit claims for all Medicare patients, and providers may not charge patients for preparing or filing a Medicare claim.
- 42 CFR 447.45(d), Medicaid timely claims payment
The Medicaid agency must require providers to submit all claims no later than 12 months from the date of service.
- EmblemHealth provider policy, Claims submission: timely filing
Participating providers must submit new claims within 120 days of the date of service (non-participating providers have up to 18 months on commercial plans), and participating practitioners may not bill the patient for services EmblemHealth has denied because of late submission.
- Texas Civil Practice and Remedies Code section 146.002, Timely billing required
A health care service provider shall bill a patient or other responsible person not later than the first day of the 11th month after the date the services are provided, and where a health plan must be billed first, by the contract deadline or that same date.
- Texas Civil Practice and Remedies Code section 146.003, Certain claims barred
A provider who misses the section 146.002 deadline may not recover from the patient any amount the patient would have been entitled to receive as payment or reimbursement under a health benefit plan, nor from a family member who would otherwise be responsible for the debt.
- Code of Virginia section 59.1-612, Billing and collection rules; limits on creditors
No medical creditor or medical debt collector may take any extraordinary collection action until 120 days after the due date of the final invoice for a health care service, with 30 days' notice. It sets no deadline for sending the first bill.
- NPR, They billed Medicare late for his anesthesia so he got sent to collections, 27 July 2023
An anesthesia group filed its Medicare claim 17 months after a Pennsylvania patient's April 2021 surgery, then billed him $2,965.58 and sent it to collections. The director of the Center for Medicare said claims filed a year or more after service are denied with no exception for provider error; the company dropped the collection effort and the patient never paid.
- CMS, Change Healthcare/Optum Payment Disruption (CHOPD) accelerated and advance payments, 9 March 2024
The late-February 2024 cyberattack on Change Healthcare prevented facilities from submitting claims and receiving Medicare payments through the platform, and CMS opened accelerated and advance payments to providers and suppliers facing cash flow problems as a result.
- CFPB, Can debt collectors collect a debt that is several years old
Collectors cannot sue or threaten to sue once the statute of limitations has passed, and making a partial payment or acknowledging an old debt may restart that period.
- Equifax, Experian and TransUnion, medical collections under $500 removed from US credit reports, 11 April 2023
Medical collection debt with an initial reported balance under $500 has been removed from US consumer credit reports. Paid medical collection debt has not been included since 1 July 2022, and the period before unpaid medical collection debt appears was increased from six months to one year.
- State laws keeping medical debt off credit reports, statutes checked 28 August 2026
Fifteen states bar medical debt from consumer credit reports, with effective dates checked against each statute: Colorado (7 August 2023), New York (13 December 2023), Connecticut and Virginia (1 July 2024), New Jersey (22 July 2024), Minnesota (1 October 2024), California, Illinois and Rhode Island (1 January 2025), Vermont (1 July 2025), Washington (27 July 2025), Maine (24 September 2025), Maryland (1 October 2025), Delaware (27 October 2025) and Oregon (1 January 2026). Scope differs by state: most bar providers or collectors from furnishing medical debt and bureaus from including it.
- IRS, Billing and collections, section 501(r)(6)
Before any extraordinary collection action a hospital must make reasonable efforts to determine financial assistance eligibility: no collection for at least 120 days after the first billing statement, 30 days' written notice, and a 240-day application window.
- CFPB, 12 CFR 1006.34, notice for validation of debts
A collector must send validation information in its first communication or within five days after, including the creditor's name, an itemised amount, the validation-period end date, and your dispute rights.
- CMS, No Surprises Act
The federal surprise billing protections, and the independent dispute resolution process for out-of-network payment disagreements.
- CMS, How to read an explanation of benefits
An explanation of benefits shows the total charges for a visit and is explicitly not a bill; it shows what the plan covered and what you will owe when the provider invoices you.
Sources last checked 9 September 2026. Medical billing rules change, so if you spot something out of date, tell us and we will correct it.
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