First call the hospital and find out if the amount is correct. Then send the HIPAA dispute letter to the CRAs.
Wait for the CRAs to verify the amount.
Then send the hospital the next HIPAA letter with the amount owed.
To protect your rights under HIPAA, you should not write or correspond with a Collection Agency regarding a medical collection account within SOL.
DISPUTE with CRAs
This process is not applicable if the account is valid and you are unable to pay. The medical claim must either be paid, inaccurate, or you are prepared to remit the valid correct amount due with the HIPAA letter.
The Pre-HIPAA letter is sent to the CRA to dispute medical collection accounts on your CR that are within SOL and are: paid, valid but unpaid, "not mine" or inaccurate.
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Dispute a paid medical collection directly with the CRA and they should delete. If not deleted, but verified, send HIPAA letter (Whychat's process - insert b).
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Dispute valid but unpaid medical collections because you need the CRA to verify the balance. There may be no valid balance due and the CRA will delete. Only after the CRA has verified and you agree that the amount is correct is the HIPAA letter sent with payment (Whychat's process - insert a). The payment amount should be the same amount as was verified by the CRA and on your CR.
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If the medical collection account is "not mine" or inaccurate, you need to have disputed the medical collection listing with the CRA. Only after the CRA verifies and does not delete an invalid or inaccurate medical collection do you send the HIPAA letter (Whychat's process - insert a or b).
DISPUTE with CRAs
PRE HIPAA MEDICAL DISPUTE LETTER TO CRA
You dispute medical accounts this way:
- Dear CRA,
- My name is xxxxx xxxxxx , my SS # is xxx xx xxxx.
- I am sending this dispute certified mail # xxxx to make sure you receive it.
- I have no knowledge or records of account # xxxxx on my report # xxxxx.
- Please advise me as to the name and address of the medical provider, the date and type of service,and to whom the service was provided, as any account I might have had would be obsolete.
- If you can obtain this information, I also would need the name of the person providing this data, and the manner in which it was provided in order that I may pursue additional legal remedies.
Very truly yours,
- xxxxxx
Make sure you HAND ADDRESS the envelope, use personalized stationery and purple or teal font, ( preferably italic).
- DO NOT send it RR -WAIT FOR THE FULL RESPONSE FROM THE CRA BEFORE CONTINUING WITH THE HIPAA LETTER PROCESS
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This letter is intended for the original creditor health care provider and is designed to obtain a deletion from credit reports, and stop collection agency activity.
- It is NOT applicable if the account is valid and you are unable to pay it.
- It will ONLY work if the claim is either INACCURATE, or you remit the valid correct amount due with the letter.
- Please make sure that your payment is in the form of a bank cashiers check or bank money order,(do not use a postal money order) that you make a photo copy of the front and back of the remittance, that your name and address are CLEARLY printed on the remittance, that it is made to the order of THE ORIGINAL HEALTH CARE PROVIDER, and that you print or type clearly in the endorsement section "For Deposit Only to the Account of (name of H.C. provider)(This of course allows your IRS deduction as a medical expense)
- Send ALL correspondence to the HIPAA COMPLIANCE OFFICE of the HC provider,CMRR. ( If the OC has changed ownership or moved or gone BK, send it certified WITHOUT the return receipt requested.) Do NOT "fax" or "e-mail" anything.
- (Your Name)
- (address)
- (City,State, zip)
- s.s.# (social security #)
- HIPAA Compliance Office
- ( 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 ($___): INSERTS ARE BELOW LETTER PICK THE CORRECT ONE.....
- Insert correct insert here
see inserts) (a) (b) or (c)
- Please 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.
- 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)
- (insert a)
- Enclosed please find my remittance of ($___) for payment in full of this account.
- (insert this if the payment is less than billed)This payment in full is for services as per the attached fee schedule from XXXX XXXX)
- Health Care Billing Charts
- Please note, my remittance is payable ONLY to (hc provider) and may not be signed over or transferred to any third party collection agency, as this would constitute an additional violation of HIPAA and State Privacy Act rules .
- Copies of this correspondence and a copy of the remittance check may be used for any further actions with State or Federal agencies
- (insert b)
- 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, therefore I request complete deletion from all your agent (name of CA)'s records and archives.
- (insert c)
- This is not my account,
- It has been billed to me in error. and has been properly disputed, therefore I request complete deletion from all your agent ( name of CA)'s records and archives.
Letter to hospital AFTER you know the exact amount owed!!!
FORM LETTER TO ORIGINAL HEALTH CARE PROVIDER
INSERTS
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