It's well beyond theoretical. The system is total nonsense.
I think a sane first step would be a N-month statute of limitations on bills. Anything you're going to be billed for should be sent within N-months. I'm not saying that it should take that long. I'm saying right now there's no limit whatsoever. You could receive a bill for some itemized sub portion (lab work, specialist, a different doctor, etc) a year after a hospital visit and you have no clue what it's for.
And this happened to me. Got a call from a collection agency claiming I owed them money a year after the birth. I called the hospital and got a written confirmation that they had no record of an unpaid or even late bill. I called my insurance and confirmed they had never received a bill for the amount claimed. Upon getting details from the debt collector (later than required by law), I saw a doctor's name. So I went to the hospital, and they had no record of a doctor by that name ever working for them.
The bill turned out to be legitimate, in that the doctor was a "traveling anesthesiologist" and was never an employee of the hospital. And they billed separately, and were never given my insurance information. The whole case ended up relying on my wife's signature on a long legal form that she signed while she was dilated to an 8. All the contact information (address, phone, company name) on the documentation led to people who could not confirm any details on the bill. The hospital told me that they have had a lot of reports of doctors who do their own billing not sending bills for months because they're not very organized.
Eventually the anesthesiologist billed it to my insurance correctly and I paid 10% of it. I later found out I could sue the debt collector for not providing details fast enough, but the statute of limitations on their violation had expired.
1 year. It was also a 1 year limit on when they could collect the bill if it wasn't billed to my insurance. Not sure if that would've counted, since the hospital had my insurance and technically I didn't give it directly to the independent doctor, but the only reason they billed my insurance days before it hit a year is because I was crazy persistent and proactive about getting to the bottom of this. Next time I'll let more of the burden of proof remain on them longer.
This happened with our first child on our PPO. We kept getting bills for over a year. I had no idea what half of them were for or who any of the doctors mentioned were. I wouldn't be surprised if some of those bills were scams from people who look for birth announcements in the paper.
Subsequent children were under an HMO, and we never saw a bill.
If scammers do use those announcements, then you would have gotten their fake bills for the subsequent children, because those scammers wouldn't know about the HMO coverage.
(One of the hospital staff could be in on the scam, and target based on insurance coverage, but then they wouldn't need the birth announcements in the paper.)
Even 2.5 years later. The worst part of that all is that you then have to waste time contacting the hospital to make sure it's a legitimate bill, contacting the insurance company - which by then might well be your former insurance company - to make sure they paid their fair share, etc.
