Medical Bill in Collections - Now being paid by insurance UPDATE

[Anonymous]

Hi,

First time poster, but avid reader.  I went to the doctor for a small routine skin procedure back in May of 2019. They sent some test to the lab and bill was for $740. I recieved the bill and sent it to my insurance. Come to find out my insurance did not pay their portion and this was sent to collections. 

I have since worked with my insurance to cover their portion ( they paid their portion in June of this year and covered about $480 of the $740) and I'm currently waiting for the medical office to send me the portion of the bill I owe. I've fought with the collection agency the past 2 months to have this removed with no luck. 

UPDATE: Just for everyone knowledge, in the short time frame that I posted my original message. I've had both Experian and Equifax remove this from my credit reports. A few calls, emails and letters (With copies of insurance statements) I was able to get Collection Credit Services to remove this. Hopefully Transunion is next within the next few days.  Great success.  Now on to my 3 late payments from 2015 (I have already peppered CAP1 and Discover with Goodwill letters...few denials so far, but will keep plugging along)

Any suggestions? 

[KLEXH25]

---

@Anonymous wrote:

Hi,

First time poster, but avid reader.  I went to the doctor for a small routine skin procedure back in May of 2019. They sent some test to the lab and bill was for $740. I recieved the bill and sent it to my insurance. Come to find out my insurance did not pay their portion and this was sent to collections. 

I have since worked with my insurance to cover their portion ( they paid their portion in June of this year and covered about $480 of the $740) and I'm currently waiting for the medical office to send me the portion of the bill I owe. I've fought with the collection agency the past 2 months to have this removed with no luck. 

Any suggestions? 

---

I'm not entirely familiar with collections, however if you are already working directly with the medical provider and insurance to pay what is owed, can't you ask the medical office to call off the collections? Especially since part of it has already been paid. Hopefully someone else with more insight can chime in. 

[RobertEG]

The National Consumer Assistance Plan (NCAP) is a published policy statement of the big-3 CRAs, and resulted from numerous agreements made by the CRAs in a settlement agreement of lawsuits brought separately by the AG of NYS and by the office of the AG of multiple states back in 2015.

One of the provisions of the NCAP is that the CRAs have agreed to remove any medical collection which is shown to have been paid by medical insurance.  You thus only need to provide the CRAs with evidence once they are paid by the insuror, and have no need to get the debt collectors to delete their reported collections.

[Anonymous]

Thank you for the input. I will be doing that next as I have multiple statements from insurance showing what they paid and what I owe.

[Remedios]

---

@RobertEG wrote:

The National Consumer Assistance Plan (NCAP) is a published policy statement of the big-3 CRAs, and resulted from numerous agreements made by the CRAs in a settlement agreement of lawsuits brought separately by the AG of NYS and by the office of the AG of multiple states back in 2015.

One of the provisions of the NCAP is that the CRAs have agreed to remove any medical collection which is shown to have been paid by medical insurance.  You thus only need to provide the CRAs with evidence once they are paid by the insuror, and have no need to get the debt collectors to delete their reported collections.

---

@RobertEG are you saying that patients cannot be sent to collections for failure to pay their portion of the medical bill?

What would happen if bill is for $1500, insurance pays $100, leaving patient with $1400 due to deductible? 

Or claims that have been adjudicated, but entire balance is patient's responsibility due to deductible and OOP cost? 

Does that mean that no Medicare beneficiary without secondary insurance can be sent to collections for failing to pay 20% coinsurance?

Or is this *They can be sent to collections, but it won't be present on CR* 

Thank you in advance

[RobertEG]

The NCAP is a based on a settlement agreement between the CRAs and the offices of the AGs of several states, and contains the agreed provisions of those two settlement agreements.

It is binding only upon what the CRAs will or must do, and does not prevent any debt collector from reporting their collection to any CRA.  If reported, the CRAs have agreed not to include the medical collector in credit reports they issue (a) until at least 180 days after initial delinquency that resulted in the collection, and (b) if the debt is paid by medical insurance.

It only applies if the debt obligation is "paid in full" by the insuror, and not to collections where only a portion of the debt is paid partially  by an insuror, with there thus being some remaining debt obligation of the consumer.

[IPIF]

My undersanding is that the settlement agreement was primarily to protect patients from in-network providers who try to balance bill.

This was a major problem some years ago and there was an article in the New York Times about it.

For example, if I go to an in-network provider and they bill insurance say $500 but insurance pays only $170 and I have $30 copay, then the provider must write off the remaining $300. But some in-network providers would balance bill the patient for the remaining $300 even thought it violates their contract as an in-network provider.

Some years ago I was an outpatient at an in-network hospital. They tried to balance bill me. I called them and they said it was a mistake. Then they sent me a 30 day late notice. I called again and they said it was a mistake. Then they sent me a 60 day late notice. I called again and they said it was a mistake. Then they sent me a notice to pay within 10 days or they would report me to their collection attorney. I sent them a letter via certified mail that if they did not set my account balance to zero within 10 days then I would report them to my attorney. They then fixed the problem quickly.

Unfortunatlely, it seems that the OP went to an out of network provider who is allowed to balance bill the patient. In addition, an out of network provider can demand payment upfront and tell you to get whatever reimbursement you can get from the insurance company.

[KLEXH25]

---

@IPIF wrote:

My undersanding is that the settlement agreement was primarily to protect patients from in-network providers who try to balance bill.

This was a major problem some years ago and there was an article in the New York Times about it.

For example, if I go to an in-network provider and they bill insurance say $500 but insurance pays only $170 and I have $30 copay, then the provider must write off the remaining $300. But some in-network providers would balance bill the patient for the remaining $300 even thought it violates their contract as an in-network provider.

Some years ago I was an outpatient at an in-network hospital. They tried to balance bill me. I called them and they said it was a mistake. Then they sent me a 30 day late notice. I called again and they said it was a mistake. Then they sent me a 60 day late notice. I called again and they said it was a mistake. Then they sent me a notice to pay within 10 days or they would report me to their collection attorney. I sent them a letter via certified mail that if they did not set my account balance to zero within 10 days then I would report them to my attorney. They then fixed the problem quickly.

Unfortunatlely, it seems that the OP went to an out of network provider who is allowed to balance bill the patient. In addition, an out of network provider can demand payment upfront and tell you to get whatever reimbursement you can get from the insurance company.

---

That's very helpful information. Does that in-network rule apply for all states? It sounds like they're banking on people not knowing their rights and bullying them into paying. 

[IPIF]

I don't think that it depends upon what state you reside in.

It depends upon your insurance company and whether they have a network of providers.

If you have insurance with  in-network providers, then those providers sign a contract which includes accepting the insurance payment plus copay as payment in full. The contract prohibits the in-network provider from balance billing the patient. 

Some policies don't have a network in which case the patient is responsible for the amount that the insurer does not pay. I guess that this is the type of policy that the OP has. Sadly in this case the patient is liable for the full billed amount if the insurer denies the claim.

I don't know if anyone is engaged in bullying. There are so many different insurers and each insurer can have several different policies so it is confusing even for providers.