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Question about medical collection

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Anonymous
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Question about medical collection

I've done my Googling and found a certain process for medical collections and posted my question there, however, the process is very confusing and to be honest doesn't truly fit my situation. Do I try to follow the instructions or is there a better/different way to get the same results?

 

Took my son to the doctor, paid the co-pay I was asked. Received additional bill later citing that visit date, the doctor he saw as well as his name. Upon calling the provider to find out why I wasn't told our co-pay was $125 versus the $50 I paid, the rep simply stated they don't always know what the charges will be until the doctor enters the codes. Please note this is an HMO but 1/1/14 our plan changed to a high deductible plan. I have to now pay $2500 out of pocket until this deductible is paid then we get co-pays. I did not pay that bill until 1/2/15, this was done online through the providers website.

 

That same evening upon arriving home, I received a letter from a CA citing several amounts owed, all from the same OC (my insurance). I sent off a D&V letter the following Monday requesting additional information because I honestly did not recognize some of the amounts listed. Monday evening I received a type of statement from the OC listing previous visits dating as far back as 2008 for my children and I and how the $75 I made online was applied.

 

Problem #1: The 2014 visit for my son was indeed only $50, which was paid at the time of service. The additional $75 bill sent by the OC was not for that visit as it states but rather for visits between 2 children for 2008, 2009, and 2013 visits as per the statement they sent after I paid. I consider this fraudulent but do not know if this was legal or not. If not, perhaps I can use this to my advantage for my next step(s)?

 

Problem #2: Of the amounts listed on the CA's initial letter to me, only one is showing on my reports as a collection. $75 of this was coincidentally paid prior to receipt of the CA's letter. Last night I received a response from the CA with documentation from the OC:

 

  1. Some of the "bills" attached to CA's response are incorrect. Some are obviously now paid via the payment I coincidentally made on 1/2. Some of the bills are for the insurance's portion (my co-pay payment is listed) and some are for the full amount (my portion plus the insurance's portion). None of this adds up to what the CA is requesting for payment (less than their attached documentation).
  2. No relationship between CA and OC was provided although requested.
  3. No confirmation that CA is licensed in my state to do business was provided although requested.
  4. My original letter clearly states I was disputing. Credit reports do not reflect this.

Solutions?

 

  1. Do I try to follow the HIPAA process even though no matter how much I read it, I still can't wrap my head around it. Also, the steps don't seem to match my situation?
  2. Do I contact the CA (advised not to by the HIPAA process author due to no relationship between them and OC provided) directly to state their documentation is screwy. Offer less than what they're requesting and request a PFD (I'd come out ahead on what is truly owed).
  3. Do I contact the OC and mention the fraudulent billing and see if I can get them to recall any amount they've assigned to a CA and pay them directly?
  4. Suggestions??

I have no problem paying the $300 listed on my reports. I do have a problem with poking the sleeping bear with regard to the other amounts previously paid (and ones not paid but not reporting) that were assigned to the CA getting reported and adding collections to my reports.

 

Not sure if this matters or not but the letter from the CA does not state anything about the bill(s) affecting my credit.

 

Sorry for the length but felt it necessary to explain the situation in detail. Thank you in advance for any help/suggestions/advice!!

Message 1 of 2
1 REPLY 1
RobertEG
Legendary Contributor

Re: Question about medical collection

Neither the DV process nor an FCRA dispute requires the party to document or prove ther validation of debt or verification of accuracy of their credit reproting.

They must investigate and provide a reasonable determination based on the results of their investigation.  There are no judges in either process to evaluate factual documentation and make a binding determianton as to any contested interpretations.

Fraudulent billing is a serious legal contention, and only the courts can rule on such an assertion.

 

As for the so-called HIPAA process, it is not a juducially reviewed process, and thus pursuit of any asserted requirements is based on interpretation of the statute by parties other than the courts.  It's legitimacy and procedures are not discussed on this site.

 

My advice would be to consult an attorney with eye towards bringing your issues before the courts for resolution.

 

 

 

 

Message 2 of 2
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