UPDATED: Medical collection not owed

Anonymous · ‎08-08-2016

Can't find much to read on this except in the archived medical debt board. None of it seems to completely apply to my situation, so I hope it's okay to ask here.

Hubby has a recent collection filed against him which is dropping his scores. He doesn't owe it. He is a disabled veteran covered fully by the VA. We received a letter from the VA after his treatment stating that they had paid the original creditor (emergency services) and that the OC could not bill us further. I presume that means the OC accepted payment in full from the VA. In any case, hubby wasn't supposed to be billed.

A year later, the OC sent it for collection and it's been placed on hubby's TU and EX reports.

What is the best process for getting it removed? Since we understood that he never owed it in the first place, I'm not sure the whole HIPAA process is the best way to go, or is it?
Maybe just a direct dispute with the CRAs would do it?

Final update: TU and EX finally did the right thing and removed this from hubby's report!

Anonymous · ‎08-08-2016

In my opinion, you should call the OC to inquire why they are billing you if VA was supposed to pick up. If it was a mistake on their end, it's much easier for the provider of services to have their CA correct/delete the negative trade line. If the OC feels like it's NOT a mistake, I would send them a copy of the explanation of benefits from the VA showing the paid bill. The only reason I can think that you would have a bill is that the OC did not accept the VA payment as full payment. (It's called balance billing).

Anonymous · ‎08-08-2016

I know about balance billing, but the VA says they are not allowed to bill the balance. I guess calling them would be a good first step. They may not know that, by accepting the payment, they were agreeing to PIF. In any case, that's the place to take their dispute. I'll give them a call tomorrow, see what they say, and update here.

Anonymous · ‎08-09-2016

I had a somewhat similar problem, my DH was treated for a job site injury so it should have all been billed to L&I, but it never was and then one day we were served with a suit for the bill...

Long story short, we ended up threatening to counter sue if everything wasn't dropped. We had a letter from the state clealy saying we could not be billed for the services.

Call up the OC and discuss it with them, have them recall the debt and send them a copy of the letter with pertinent information circled or highlighted if nessecary. This should clear things up. If not, you might need to talk to a lawyer.

Anonymous · ‎08-15-2016

Just thought I'd share what I've found out so far, just in case it will ever help anyone else. If you are a disabled veteran covered by the VA (and do not have other insurance), pursuant to the US Code, balance billing is illegal if any payment from VA was accepted. I'm not sure if we're supposed to post links here, so I won't, but I have the US Code citation, so if anyone needs it, PM me.

I haven't done the research but I suspect the same is true for Medicare and Medicaid, so if you're in that boat, I urge you to search it out. Don't just pay it!

We have a letter from the CA stating that we should not contact the original provider since they no longer have authority to settle, which indicates to me that he bought the debt. He included all the debt info that he would send if we asked for DV, so we're going to skip that step. Hubby is a lawyer, so for us, the most straightforward way is just to send a "legal" letter directly to the CA, citing the U.S. Code, and include the supporting documentation from the VA and the provider. The letter will also give the CA a deadline (so it doesn't sit on someone's desk till they get around to it).

That will probably be sufficient, but if not, then I guess we'll have to send it all to the provider as well. May do that part anyway. If they don't know this practice is illegal, they should have the chance to refuse the VA payment next time. If they do know, maybe next time they'll think twice about sending these to other unsuspecting patients. Besides that, I'd rather not see this show up again 6 months now from a new CA.

I guess we'll also file disputes with the CRAs if it becomes necessary. I'll update again when there's any movement.

Anonymous · ‎08-15-2016

I just want to point out that balance billing is essentially always illegal. If you receive a bill following contracted payment through either insurance, medicare or VA benefits, it's illegal.

If you are getting services not covered by your health insurance plan (not covered like, won't even negotiate a contracted rate), have no relationship to your insurance company, the provider is required to tell you in advance an estimate of the costs of the procedures, and often require a down payment. While this is still "balance billing," most people don't refer to it as such because it's not a surprise. Even if the costs are more than estimated, you go in knowing there will be out of pocket expenses.

Anyone experiencing what you are should be taking legal action. I currently have a doctor's practice that billed my insurance $1900 for a pelvic exam + ultrasound, and Collective Health paid $280 for their contracted rate through the hospital. They kept sending me a bill for the balance saying my insurance company never responded to their claim and that I was now responsible for the debt. I faxed them a copy of the statement, they claim they didn't receive that either! CROOKS.

Best of luck, don't give up, and start litigating if necessary. They are knowingly breaking the law.

RobertEG · ‎08-15-2016

I would highly recommend, before sending any intent to sue letters, that you first send a formal dispute under FCRA 611(a) of the accuracy their credit reporting to the CRA, and include your supporting documentation and arguments. A formal dispute under section 611(a) has a requried period of 30 days for the CRA to complete its reinvestigation, and a period of no later than 5 business days thereafter in which to send the formal Notice of Results of Reinvestigation, so unlike a DV request, a formal dispute does set a required period for resolution. It also then, if they verify the accuracy, serve as basis for subsequent civil action that a consumer would not otherwise have.

A consumer does not have the right to bring private civil action against a party for knowingly or negligently reporting inaccurate information, but can, after filing a dispute and giving the furnisher the opportunity to correct, file a civil action asserting lack of proper investigation of their dispute. See FCRA 623(c) amd (d\).

Filing of a dispute via the CRA should be the preliminary step before pursuing private civil action for reporting of inaccurate information.

Anonymous · ‎08-16-2016

So far, the damage is negligible, so nothing really to recover through legal action. But that may change any day, so it's definitely in their interest to get it off his report pretty fast.

I think a lot of them definitely are crooks. According to a lot of the articles I ran across, they are getting away with it merely because so many people don't know. They get called by these intimidating CAs and so they just pay it.

In my state you can be balance-billed if the provider isn't in your policy's network. It's unfair because, even if you are diligent, there are just way too many tricks out there to trip you up. I like to think I'm a fairly savvy consumer, but you know, the networks have gotten so small, and insurance companies don't always keep their provider lists up to date. If you go to a hospital, you may have thought you were pre-approved, but they pull in all kinds of auxiliary providers, and you may be asleep on the operating table when they do. Even if you're awake, what're you going to say? No, stop this surgery, I can't use that anesthesiologist?

On this particular visit, someone called in a nephrologist for hubby, who visited him EVERY day. Totally unnecessary and therefore totally not covered.

Anonymous · ‎08-16-2016

Thanks for checking in, Robert; I appreciate having someone with your experience. My husband is an atty but not in this area, so that's very helpful.

Actually, we were planning to contact the owner of the debt (atty) first, and give him the opportunity to remove it himself. As a medical debt collector he should know that his claim is prohibited, but it's possible he may not have seen documents showing payment from a government agency. We'll provide those documents, and we're hoping he'll correct it. We weren't planning to suggest legal action unless/until he refuses or fails to respond.

The dispute to the CRAs is planned if he doesn't timely respond. Is there a legal reason we should take the formal dispute step first?

Anonymous · ‎08-16-2016

@Anonymous wrote:
So far, the damage is negligible, so nothing really to recover through legal action. But that may change any day, so it's definitely in their interest to get it off his report pretty fast.

I think a lot of them definitely are crooks. According to a lot of the articles I ran across, they are getting away with it merely because so many people don't know. They get called by these intimidating CAs and so they just pay it.

In my state you can be balance-billed if the provider isn't in your policy's network. It's unfair because, even if you are diligent, there are just way too many tricks out there to trip you up. I like to think I'm a fairly savvy consumer, but you know, the networks have gotten so small, and insurance companies don't always keep their provider lists up to date. If you go to a hospital, you may have thought you were pre-approved, but they pull in all kinds of auxiliary providers, and you may be asleep on the operating table when they do. Even if you're awake, what're you going to say? No, stop this surgery, I can't use that anesthesiologist?

On this particular visit, someone called in a nephrologist for hubby, who visited him EVERY day. Totally unnecessary and therefore totally not covered.

Litigating if they fail to comply isn't for you to recover damages so much as to stop them from doing this. Reporting it and taking legal action is the best way to encourage others to fight for their rights, too. Eventually, the government gets involved, which is why Prime Hospital network is currently under investigation for billing and medicare fraud. They've been over $1B illegally, so just imagine how many other entitities are doing the same thing. People don't know their rights and most people just pay the bills they receive without question, or to get them off of their credit reports without disputing whether or not the medical debt is legit, provided they received services during the time that is stated at the facility stated.

If they do not comply with the actions Robert suggested, I would file a complaint and send a letter of intent to sue.