How long does a hospital have to bill a patient for an out-patient procedure?

March 10, 2015 16:07 by Consumer Ed

Dear Consumer Ed:

How long does a hospital have to send me a bill for an out-patient procedure?  It has been four months since the procedure, and it is hard to know how to budget for this expense. In addition, it may be too late by the time I get the bill to claim it as part of my medical expenses on my taxes.

Consumer Ed says: 

First of all, it may be helpful to make sure you are actually an outpatient.  Your hospital status, i.e. whether the hospital considers you an “inpatient” or “outpatient,” affects how much you pay for hospital services (like X-rays, drugs, and lab tests).  For example,

  • You are an inpatient when you are formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
  • You are an outpatient if you are getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital.

Your hospital status also affects whether the law clearly mandates a timeline for hospitals to provide you with a bill.  If you were an inpatient, Georgia’s Fair Business Practices Act requires a hospital or long-term care facility to provide you an itemized statement of all charges for which you are being billed within six business days after you have been released from its care. It does not contain a similar deadline for hospitals to issue a bill for outpatient services or procedures.  However, there are several steps you can take to speed up the process.

First, you should contact the hospital’s billing department and inquire into the status of your bill. Hospitals generally have specific billing timelines, and processes to follow. The Georgia Administrative Code mandates that hospitals should develop, implement and enforce policies and procedures to ensure that each patient is provided an itemized statement of all charges for which the patient is being billed.  Hospitals are also required to provide, upon your request, a written summary of hospital charge rates per service to allow the patients to assess the charges and make cost effective decisions in the purchase of hospital services.  The American Hospital Association issued similar guidelines to encourage hospitals to respond promptly to patients’ questions about their bills and to use a clear and patient-friendly billing process.

Under Georgia law, patients have the right to inquire as to the estimated charges for a routine office visit, routine treatments, and lab tests prior to receiving such treatment.  It’s still the patient’s responsibility to determine the insurance coverage, but you can always ask the hospital about the costs associated with routine office visits, routine treatments, and lab tests.

There may also be a timely filing requirement for hospitals, depending on what type of medical insurance plan you have:

  • If you have Medicare, the Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided.
  • If you have Medicaid, the provider must file the claim three months following the month the service is provided.  If you have Medicaid and a third-party insurance plan, in general, your provider will bill the third-party insurance plan first, and then to Medicaid for consideration of payment not to exceed the sum of the deductible, copayment, and coinsurance.  If you have Medicaid and a third-party insurance plan, effective July 1, 2011, Medicaid must receive the claim after the third-party insurance, but within 12 months of the date of the month of service.
  • If you have private health insurance, the insurance company may only accept claims submitted by health care professionals within a specific period of time.  For example, Cigna only considers in-network claims submitted within 3 months after the date of service.  This timeline may be longer if the treating physician is out-of-network.  You should read your insurance company’s Explanation of Benefits (EOB) to see if it has a similar timely filing requirement. You can also contact your insurance company to find out whether your hospital has already provided it with your medical bills.

Additional questions about this? Here’s who to contact:

  • What is covered by my insurance?   
    Contact the insurance company directly. For Medicare, go to For Medicaid, visit
  • Claiming tax exemptions for medical expenses
    Contact the IRS -
  • A Georgia hospital did not provide an itemized statement of the charges you are being billed for.
    Contact the Georgia Department of Community Health -
  • A Georgia hospital or long-term care facility did not provide a detailed bill for in-patient hospital stay within 6 business days.
    Contact the Georgia Department of Law’s Consumer Protection Unit –
  • Filing a complaint against a health insurance provider   
    Contact the Office of Insurance and Safety Fire Commissioner -


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As a Tennessee resident, do I have to pay GA sales tax on a car purchased in Georgia?

August 14, 2014 18:20 by Consumer Ed

Dear Consumer Ed:

I'm looking to buy a used car in Georgia, but I live in Tennessee. What is the law for collecting sales tax? I've been told Georgia dealers won't collect sales tax. I’ve also heard that if I pay cash, they won't collect sales tax, but if I finance it, they will collect my Tennessee tax and mail it to Tennessee. The Georgia Secretary of State said by law the dealer must collect Georgia sales tax and I may also have to pay Tennessee sales tax. Is it up to the dealer?

Consumer Ed says: 

The decision to collect Georgia taxes on the purchase of your vehicle is not in the dealer’s discretion. Instead, it depends on whether you apply for certificate of title in Georgia or another state (like Tennessee).  On March 1, 2013, Georgia’s motor vehicle tax rules changed:  as of that date, instead of the old sales tax, use tax, and annual ad valorem taxes being levied, any car purchased or leased and then titled in Georgia will instead be subject to a one-time tax called the Title Ad Valorem Tax fee (“TAVT”).  The TAVT is now the sole and exclusive method for taxing the purchase price of an automobile.  The TAVT is calculated by multiplying the Fair Market Value of the vehicle by the TAVT rate, which is currently set at 6.75% through the end of 2014.  The new law requires dealers to collect this TAVT from the customer, then submit the TAVT and the application for certificate of title to the particular county in Georgia where the vehicle will be registered.

But if you purchase a vehicle in Georgia and apply for certificate of title in another state, the dealer may not necessarily collect sales tax, use tax, or even TAVT on your behalf.  Instead, the dealer may have the purchaser execute a Nonresident Certificate of Exemption Purchase of Motor Vehicle (also referred to as Form ST-8), to allow for a “drive out” exemption.  This certificate is signed by both the purchaser and the dealer to affirm that the nonresident purchaser will immediately transport the vehicle out of Georgia and apply for title in his/her state of residence.  There are circumstances, however, particularly with financed transactions, where the dealer may collect and remit taxes on your behalf. Regardless, nonresidents won’t pay TAVT or Georgia sales tax, but will be subject to the taxing rules and policies of their home state when they apply for a certificate of title and register their vehicle in that state.

Keep in mind that if you later become a Georgia resident, you’ll be required to pay the TAVT on your vehicle.  This is because new residents moving into Georgia are required to register and title their motor vehicle in Georgia, which is when the TAVT is charged.  According to the new motor vehicle tax rules, new residents must pay 50% of the TAVT within 30 days of moving to the state, and the remaining 50% must be paid within the next 12 months.

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Can you negotiate or lower the amount you owe the IRS? (Part 2 of 2)

April 8, 2014 21:33 by Consumer Ed

Dear Consumer Ed:

Can you negotiate or lower the amount of taxes that you owe the IRS, or are the companies that claim they can do this not legit?

Consumer Ed Says:

Yes, in certain, limited cases you can arrange to pay tax debts through a payment plan (called an installment agreement) or settle outstanding tax debts for less than what you actually owe (called an offer in compromise or OIC). However, in order to apply for these programs with the Internal Revenue Service (IRS) or the Georgia Department of Revenue (GDOR) you must first explore all other payment options. Even if you qualify, strict requirements and restrictions apply.  Last week's column delved into this subject as to the IRS and federal taxes.  This week, we're taking up the Georgia related aspects of this question.

Georgia Department of Revenue and State Tax Debts 

Georgians are taxed according to a graduated tax rate. You will be charged a set amount (based on your taxable income and filing status) plus a percentage of your taxable income above a given number. The percentage varies depending on your taxable income but the maximum tax rate is set at 6%. If you do not pay your state taxes, the State will begin its collection procedures. However, the GDOR also has installment agreement and offer-in-compromise programs if you owe back state taxes and can't pay in full. Although similar to the IRS programs, Georgia's requirements and application processes are separate, so you must apply for them separately.

Georgia Installment Agreements

According to the GDOR website, if you are legitimately unable to pay your taxes in full by the time they are due, you may request a payment agreement within guidelines set by the GDOR. You would do this by filing Form GA-9465 to request a monthly installment plan. However, according to the form's instructions, you don't qualify if you: (1) are currently in bankruptcy; (2) have unfiled state tax returns that are past due; (3) have a pending offer in compromise with the GDOR; or (4) your state tax liability has been assigned to a private collection agency. For more information, visit the GDOR Installment Payment Agreements webpage.

Georgia Offers in Compromise

Some Georgia taxpayers may qualify for a Georgia OIC, which lets you settle an outstanding state tax debt for less than the full amount that you owe. According to the GDOR Offer in Compromise Booklet, you can apply if: you are not able to pay the taxes you owe in full even by selling assets or through an installment agreement; a legitimate doubt exists that you owe part or all of your assessed tax debt; or special circumstances exist that would make full payment of the taxes owed an economic hardship. However, you can only apply if you have filed all required tax returns and reports; you have received a final notice of assessment for all Georgia state taxes that you owe; and you are not the subject of an open or active bankruptcy case. For more information, visit the GDOR Offer in Compromise webpage. If you need assistance in completing the application, you can contact the GDOR at (404) 417-6543.

Georgia Resources

If you owe taxes to the State of Georgia, below are resources that may be helpful in determining your payment options:


The Taxpayer Advocacy Office is a unit within the GDOR that serves Georgia taxpayers. As stated on the GDOR website, this office may be able to assist you if you: filed a protest of a Notice of Proposed Assessment; were not given fair and equitable treatment as stated in the Georgia Taxpayer Bill of Rights; or the GDOR has not responded to your specific, written inquiry after 90 days. To learn more, visit the GDOR Taxpayer Advocacy Office webpage.

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