collection

[mmts0717]

In 11/2006 I was seen by a doctor and paid my copayment and they were to file with my insurance.For 1 year, I have been back and forth between the hospital and my insurance trying to get this 129.00 balance paid. My insurance kept stating that the doctor was not providing his provider ID number so they could process the claim, the denied the same claim 4 times and each time asked the hospital to provide this. The hospital stated that they have provided the ID number, etc. In June and July of 2007 I called and asked the hospital if I could get that information and sent it certified mail to them, they responded no, that they would file it.

In November 2007 they turned it over to a collection agency.  I contacted my insurance to check the status of the claim, and the reply was the same, no doctor provider number to process claim. I called the hospital and explained this to them and complained about being turned over to collection when I had been running around trying to get this bill taken care of.

So, I sent a certified letter to my insurance asking about the claim once again. I got their reply back last week stating that the doctor had not provided the provider number and that they had requested it 4 times from the hospital.

Then last week I receive an alert that the collection agency has placed this on my file. 

I was pretty livid and called the hospital and spoke with a supervisor and explained to her that I had been in constant contact with both them and my insurance agency over the past 11 months and both were stating something different to me. I pay health care coverage and that the insurance will pay if they will provide the correct information. I asked them to pull this from the collection agency and remove it from my credit report because this was their error and not mine, which they refused. She said if I could get the fax number to my insurance, she would personally send it. I called the insurance got the dates of which they denied each claim and asked for the doctor's provider number. I tried to call the supervisor back to give her this information but she has not called back. (She said once the insurance pays, they will mark the account as paid on my credit report, go figure)

I called the collection agency to explain and ask them to remove this from my credit; they replied that the hospital had called and the account was on hold for 30 days and no action will be taken but refused to remove it from my credit report and they refused.


Where do I go from here; I feel like I am caught in between the hospital and insurance. I can't get the hospital to provide me with the doctor's ID and I can't get the insurance to pay without that information and now the collection agency is put on hold by the hospital and STILL the collection account is on my credit as just being added on 12/07  any suggestions on how to handle this?????? You guys and gals are a great source of help.... any suggestions will be appreciated.

[Boswd]

Had a similiar situation, thought it didn't get at as far as a collection.   I called my insurance company and we conferenced in the medical facilities billing department and everything was cleared up.

[Anonymous]

I  CANNOT take credit for this letter!!!!  Tweak the red part

(Your Name) (address) (City,State, zip) s.s.# (social security #) Legal Dept. ( health care provider creditor) (address) (date) Dear Sir/Madam; This letter is in reference to (account #) for services provided to (name of patient) on (date of service).In regard to the bill on this account in the amount of ($___): This account is in error. It has either been paid, is a billing error,or was not transmitted in a timely manner to my insurance company. It is not a valid bill and has been properly disputed, thereforePlease be advised that under Federal Statutes. the Fair Credit Reporting Act, (15 U.S.C. § 1681 et seq)and (name of your State)'s Consumer Credit Statutes, you may be held liable for the actions of (collection agency name).    .

(a) Duty of furnishers of information to provide accurate information. (1) Prohibition. (A) Reporting information with actual knowledge of errors. A person shall not furnish any information relating to a consumer to any consumer reporting agency if the person knows or consciously avoids knowing that the information is inaccurate.

In addition, the HIPAA and (name of your State)'s Medical Privacy Statutes are in effect in this situation even though the health care services you provided may have been prior to enactment . The Privacy Rules prohibits a covered entity from using or disclosing an individual's protected health information ("PHI") unless specifically authorized by the individual or otherwise allowed under the Privacy Rules. In general, PHI encompasses substantially all "individually identifiable health information" that is transmitted or maintained in any medium. "Individually identifiable health information" includes health information that is created or received by a health care provider, health plan, employer, or health care clearinghouse, and that relates to an individual's physical or mental health or condition, including information related to an individual's care or the PAYMENT for such care.Your furnishing of my account information to (collection agency name), is not in compliance with HIPAA,or (name of your State}'s Privacy Act, and any subsequent reporting of this account on my credit reports to (credit reporting bureaus) is a clear violation of Public Law 104-191 ("HIPAA") since there can be no permissible business purpose in divulging protected health information to anyone on an account once there is no longer any payment due.You are required under the FCRA and FACTA to accurately report the status of any account to the credit bureaus, and you are prohibited under the HIPAA and State privacy regulations from doing so on a PAID account, as there is no longer any permitted business purpose.  When you failed to properly transmit the requested information to my insurance company and only re-submit information that the insurance company telling you is inaccurate, by your own negligence you lose any right to collect on this bill from me. I have made FOUR attempts to assist you in submitting this bill properly and everytime you repeat the same error.  My Insurance company assures me that they will pay this bill if you submit properly. (Attach any documentation from your INS CO as to why this was denied).Therefore I am requesting you promptly rescind all such account information furnished to (collection agency) and require them to purge their records of all reference to this account, and that you insure that any and all reporting of this account is immediately deleted from my credit reports.This simple procedure to request the deletion of ALL reference to this account from the records of ( collection agency name) and to require them to have this account information deleted in its entirety from my credit reports will resolve this problem completely. Please respond, in writing within 10 days that you are processing this request. I am reserving the right, to take appropriate legal and civil action including reporting to any applicable regulatory authorities any lack of cooperation or compliance with this request. I hereby waive my rights under HIPAA and any State Privacy Act for the single purpose of your transmission of this request and accompanying documentation in any required report you must make to your E &O insurance carrier. Sincerely,signature (Your Name)

Message Edited by Lady_Scarlet on 12-17-2007 06:37 PM

[Anonymous]

When a problem like that exists the best thing to do is to pay it first and then do the backtracking to get your money back. Credit is much too valuable to play games even if it is not your fault and you know exactly that the problem is from their end. Did you not have 127 dollars to pay. Furthermore, when the collection agency contacted you. You should have immediately disputed the charge under all of the information that you believe the charge is incorrect and not your responsibility but the responsibility of the insurance and the physican. That way you would have in essence bought some time. Remember the collection agency is a friend....why do i say this....well sometimes people do not know about a bill and it sits in collection FIRST, before it makes a mark against your credit company. So appreciate that aspect of it. But when you try to battle something out like that you will lose everytime.

[sadie71]

Thanks for the info.  Honestly, I thought I was going about it the right way, contacting both parties and trying to get each one to do what they needed to in order to get the account paid.  When I received the letter from the CA, I contacted the hospital because they knew I was working on this and not ignoring their request.  I pay 400 a month for health insurance and it does pay if it has the correct information to process the claim.  The hospital I think has an obligation to either file my insurance for me or provide me with the information to file myself.  If they are unwilling to relase the doctors ID then this would be impossible for me to have filed the claim.  I carry insurance so that if I need it then it is there.  I think if I would have paid the bill up front, I would be out of my money because the hospital refused to provide me with the information after several request to give me the doctors federal ID number to provide to my insurance.  SOMETHING, does not seem right about this.   I sent the hospital a certified letter last week and they have not responded.  They are also setting on another account from 01/24/2007  for 429.00 that once again has the same information - no doctor federal ID number provided with multiple request by me and the insurance company to obtain this.  My insurance has sent me a letter saying that the statue of limitation is running out and that they have attempted to get the federal ID for the doctor and their attempts have not yielded anything - they also provided the same letter cc to the hospital.  My credit is important and I can see your point in me paying and then trying to get the information but if they have already denied my request and have ignored my insurance, I doubt if I pay the bill in full that they will provide this information and I will be out over 600 dollars for the 2 claims not to mention the 400 that I paid in November and January to have coverage in the first place.  If this is the case, then it does not benefit me to have health care coverage.