Question on Medical Collection

[Anonymous]

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MrProsperity wrote:
Idaho is the state, he thinks she signed her name as the guarantor, not his, but the dental insurance was in his name. A portion of the services were covered by his insurance.

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If the claim was this year, have him check online at his insurance company. They'll likely have the claim info complete with how much was paid, how much was allowed, how much was patient responsibility, etc. With that in hand, call the insuance company, play dumb, and ask for help.

Hi, um, ah, I was looking at a claim, and, umm, er, I'm hoping you can help me out with something.

Have date(s) of service, name of the patient, and name of the provider handy. Ask how much was patient responsibility. Even if the claim clearly states it, ask. More than once I've found somewhat obscured and less than clear info on insurance claims.

Make sure he brings all of this info to the attention of his lawyer. The estranged wife could continue to do this and further harm him. Go to the doctor, incur charges, fail to notify him, and fail to pay it.

Message Edited by Noah_Bodie on 12-05-2007 06:46 AM

[Anonymous]

MrProsperity, barring the success you might experience with Noah's great advice, I would suggest that your friend PFD with the original creditor.

I too live in a community property state(Texas). And I too had a med collection go into collection(with a hospital), for an e.r. visit from my daughter. I was the financial responsible party. And I was not even aware of this bill, not to mention the collcetion.

In my case, I called the hospital directly, and negotiated the PFD saying I'd pay immediately with a cashier's check, IF and ONLY if they would instruct the ca to delete the record from my cr, as the bill was incurred not by me, but my daughter. They agreed. And before I handed the csr my cashier's check for full amount, she gave me an original duplicate of the hospital's letter instructing them to delete the account. The sent me a letter about a week later, saying they deleted the collection from my cr as the bill was not mine.

In this instance, I was lucky as the hospital still owned the account. Had the hospital sold my account to ca, I would have taken a different approach.

Good luck to your friend.

[Anonymous]

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Sylviatob wrote:
I would suggest that your friend PFD with the original creditor.

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PFD tends to have better success with medical collections, but medical providers are notorious for overbilling and dentists are the worst in my experience. The OP's friend might not even owe anything. It's worth it to find out first, IMHO.

[Anonymous]

per most insurance agreements between the provider and ins co, a provider is to accept the ins co's payment as payment in full for services with the exception of you co-pay.  Run this down with the ins co - and if the dentist is billing for the balance then file a complaint with the ins co for violating his contract with them....and then tell the med guy to get this off or you will file against him with his state board, the AG's office (fraud), etc....

[Anonymous]

I totally agree Noah. That is why I implied he should explore your suggestion, as it's more logical, and economical too. No need to pay for something that's not his.

Guess I should have implicitly stated that. My bad.

[MrProsperity]

Okay, thank you, this is excellent information, as usual. I will let everyone know which way my friend decides to go -

[Anonymous]

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fused wrote:

Did this summary of services include procedure codes with a description and diagnosis codes with a description?

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Hey fused,

I'm not very familiar with the laws related to medical collections.  My mom has a few listed on her credit report from 2002 - 2005.

I sent a letter disputing one of them & requesting validation because she didn't recall - It was validated from 2002 and listed below is what was sent.

What should the plan of action be if a collection agency on a medical collection sent information like:

ICD9: 530.01         DESCRIPTION: GERD / Reflux / Esophageal

ICD9: 564.5           DESCRIPTION: Diarrhea, Functional

CODE:  45356      MODS: 80      DESCRIPTION:  Facility fee / Colonoscopy
CODE:  45323      MODS: 86      DESCRIPTION:  Facility fee / EGD Biopsy

It looks as if they've sent personal medical information.  Oh, they also sent a copy of the medical consent for treatment. 

1) Should the CRA have access to this information?

2) Is this a violation of HIPPA?

Also, there was insurance informaton listed; m not sure why it wasn't covered by the insurance (possibly delay or error in billing).

[haulingthescoreup]

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@Anonymous wrote:
ICD9: 530.01 DESCRIPTION: GERD / Reflux / Esophageal

ICD9: 564.5 DESCRIPTION: Diarrhea, Functional

CODE: 45356 MODS: 80 DESCRIPTION: Facility fee / Colonoscopy
CODE: 45323 MODS: 86 DESCRIPTION: Facility fee / EGD Biopsy

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The ICD-9 codes are diagnosis codes, and the 5-digit, no comma codes are CPT procedural codes. (Inpatient procedures also have ICD-9 procedure codes, but they only have 2 digits before the decimal point.) If diagnosis codes are protected information, then this would be a HIPAA violation.

Are you a hospital-based nurse, and if so, do you work at a different hospital? You might want to ask your hospital privacy officer for their independent opinion. Again, if the diagnoses are not to be revealed, this certainly looks like a HIPAA violation. (I'm a little surprised that the CPT codes aren't protected as well --certainly some of them are VERY revealing about what was done and why!)

This is a facility bill, from a hospital outpatient GI lab or from a free-standing facility. Does your mom remember if the physician's bill was paid OK? It would probably have the same codes (diagnosis codes might be a little different), but the modifiers on the CPT codes would be different, maybe 45356 and 45323-59 or something similar.

[Anonymous]

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haulingthescoreup wrote:

The ICD-9 codes are diagnosis codes, and the 5-digit, no comma codes are CPT procedural codes. (Inpatient procedures also have ICD-9 procedure codes, but they only have 2 digits before the decimal point.) If diagnosis codes are protected information, then this would be a HIPAA violation.

Are you a hospital-based nurse, and if so, do you work at a different hospital? You might want to ask your hospital privacy officer for their independent opinion. Again, if the diagnoses are not to be revealed, this certainly looks like a HIPAA violation. (I'm a little surprised that the CPT codes aren't protected as well --certainly some of them are VERY revealing about what was done and why!)

This is a facility bill, from a hospital outpatient GI lab or from a free-standing facility. Does your mom remember if the physician's bill was paid OK? It would probably have the same codes (diagnosis codes might be a little different), but the modifiers on the CPT codes would be different, maybe 45356 and 45323-59 or something similar.

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that's the thing... she doesn't remember anything about the bill.  from the looks of things, I thought that it was a violation of HIPPA too.  Should my steps be to follow up with the original creditor?  Initially, I was going to send a PFD letter because the bill is only $90. - but, I'm not sure how they react to PFD letters - I didn't know if my best bet would be with the original creditor with a PFD because of the HIPPA violation.

And, yes, I am a hospital based nurse.  I can try to follow up with my employer and see what they think.

[Anonymous]

You could also try calling the OC and play the I dont know card cause you are trying to help your mom out and see if you Paid it in full if they would remove it. I had a few of my own removed by calling them and they even put me in for finacial help and lowered what I had to pay them. Its with a try anyway

Debbie