Help with Medical Billing Question

[Jacque383]

Hi,

On my credit report was listed a medical collection. With Noah's (thank you) adivce I called my insurance company and found out that the bill was incorrectly submitted. This billing was in 10/2003. My insurance company has twice now requested copies of the hospital's records, with the latest request in Feb 2007. The hospital has never responded to the request.

I did ask if the hospital sends them the file would they pay the bill. She said, "yes, but they have to see the records first."

I'm unsure how to proceed and don't want make a mistake.

So would you all suggest I call the hospital and ask why they have not sent the file as well as to remove the bill from collections?

Should I send the collection agency a letter?

I'd love some suggestions on how to handle this....

Thank you.

[Anonymous]

See if you can get the insurance company to fax you a written statement. Something to effect of:

Thank you for your inquiry of July 20, 2007 regarding the hospital bill from October 2003. Our office has requested records from the hospital on one or more occassions, and we are still waiting on those records. These appear to be covered expenses, and XYZ Insurance will pay the claim once those records are received.

Anything along those lines in your hands will help. You don't wanna mention lawsuit, but it is leverage you could use against the hospital if it ever came to that.

You probably wanna try and lead them to fax you something showing their efforts to obtain the records without feeding them the specific language. Might sound like you're leading them towards building evidence for a lawsuit.

I would also call the hospital billing department, tell them who you spoke with at the insurance company, their direct line, account number, reference number, date of service, and any other pertinent info. Tell 'em insurance has said they will pay, but they just need the requested records.

[Jacque383]

My first instinct was to pick up the phone and call the hospital. I sat on hold with them forever and then hung up because I got to thinking "what if" they don't pay it, does this start the clock all over again. This was from 10/2003.

[Anonymous]

Restart the clock on SOL or CRTP?

http://ficoforums.myfico.com/fico/board/message?board.id=generalcredit&message.id=17466

[Jacque383]

Whew...I actually read every word of that!

As I understand it the CRTP is set and can't change...So no worries there....

However, the SOL can change (did I interpret that right?) so that's something to think about.

Let me explain this situation better, it might help or it might be useless...

This was my daughter riding her bicycle (small bike) and hit a parked car  (we left a note, but the car disappeared and we never heard from them - no scratches or anything on the car)- at the time I was teaching at the Virginia Tech in VA. She hit the car and was taken to the emergency room.  Directly after that I moved to a different state. Never got a bill, never heard a word, assumed it was taken care of. I did get a letter from my insurance company requesting more information, which I mailed to them and explained what happened.

Pulled my credit report a month ago and it's in collections.

Insurance company said it was billed as an automobile accident and therefore denied because auto accidents go through auto insurance companies. Because of my mailing the insurance company the information form back, they requested the records. Which were not received.

My concern is....Could this possibly be billed as an auto accident (I didn't see it that way, but insurance if different and we have no information on the car she ran into with her bicycle.)...If they receive the records and then deny it anyway, is the possibility of restarting the SOL a concern? If so, maybe it's best to try another tactic.

I don't know...what's you're opinion?

[Anonymous]

SOL can get reset, but payment is the thing that usually resets SOL. Denial of a claim, submittal of a claim, I would not think impacts SOL. But, SOL is a deep, deep subject.

Definitely sounds like the hospital incorrectly billed this as an auto accident, which it is not, and they simply need to give insurance the requested info to get paid.

If you call the hospital, I would avoid any payment issues or questions, and just tell 'em that the insurance company needs records so that the insurance company can pay them. If you can get the insurance company to send you something, then fax that to the hospital, then you could avoid any direct questioning.

There's enough complexity in this that I'm tempting to say give a consumer lawyer a call. Try either naca.net or myfaircredit.com

You really want a lawyer with insurance experience, not so much one with credit/debt experience. It's really an insurance issue, and if done correctly I think you can get insurance to pay and the hospital to delete it's collection.

Oh, and I would DV the CA. I don't see any liability on your part for this debt, particularly given that the hospital won't give insurance the requested info.

Only thing I can figure is the hospital is worried they'll get sued by you, for whatever reason.

[Jacque383]

Thanks as always....

[Jacque383]

Uggggghhhhhh.........I am so frustrated it's not even funny....

Conversation with hospital - 1. Even though it was a bicycle hitting a parked car they still consider it an automobile accident and will not change the billing code. 2. They claim the last  they heard from my insurance was 2004 and therefore they will not take it out of collections. 3. They will not send a copy of the medical records to insurance. 4. They will not make any changes what-so-ever. 5. They will not even call the insurance company to verify for themselves.

Conversation with Insurance - 1. They do not have anything to send me that says they've contacted the insurance company. However, they did send it to the investigations department to see if they can just pay it without the medical records.

Conversation with hospital - 1. Even if insurance company pays it without records they will not remove it from collections...

Medical bills shouldn't even be on credit reports in my opinion. Most lenders often overlook medical collections. This is so frustrating! I'm going to Starbucks and getting a gigantic, multiple overdose of caffeine today!

[Anonymous]

If insurance ends up paying the whole thing, then I think you have solid grounds to get the collection deleted. They screwed up in their coding of the claim and are refusing to correct it.

Probably would be necessary to run it past a lawyer who knows FCRA/FDCPA issues. Hospitals often don't know the collections biz like CAs. The hospital might take some silly stupid stand on principle whereas a CA might know they weren't on any semblance of solid ground.

[Jacque383]

I was looking up some attorney's numbers today...I hate to spend the money on attorney's if I can help it, but this one is probably going to become necessary, unfortunately.

I can't figure out if this would fall under the Virgina SOL or Washington SOL? It happened in Virginia, but I live in WA.

Anyway, thanks for the response and thoughts.