Medical Collection

[Anonymous]

This is a letter I am thinking or trying to use to validate medical bills.

Honest opinions please!

To Whom it may concern,

Re: Account Number XXXXXXXXX

I am contacting you regarding a collection placed on my credit. I respectfully request that you provide me with validation of this debt.

Please send me the following information:

The address and contact information of the original creditor as well as the account number. 
Any documentation that shows the amount owed and verifies that I am the debt owner and have obligated myself to pay such a debt. 

Details of the account such as its age, the last billing statement, an explanation of any accrued interest, and the date on which the original creditor deemed the account delinquent. Proof of billing any insurance, Veterans Administration as well as Medicare, any rejection notices from any of the fore mentioned entities as well as the clause in the contract that allows for of untimely billing. The rejection notice from Medicare as well.
A statement of whether the account is within the statute of limitations and how you concluded such.
Please have all these documents notarized to the validity on each step and by who did the validation, who it was verified by with date and time.
I am allowed under the Health Insurance Portability and Accountability Act (HIPAA) to protect my privacy and medical records from third parties. I do not recall giving permission to [name of provider] for them to release my medical information to a third party. I am aware that the HIPAA does allow for limited information about me but anything more is to only be revealed with the patient’s authorization. Therefore my request is twofold—validation of debt and HIPAA authorization.

Details of your authority to collect such a debt. Please forward any licensing information that you have. 

Sincerely, 

Your name

Thank you for reading.
ks

[dragontears]

Are you in the 30 day debt validation period? If you are, then the request will impose a cease of active collection attempts until they validated the debt. It doesn't mean they have to respond, it doesn't mean that the account should be deleted because they don't respond. 

If you are not in the 30 day window after receiving a dunning notice the CA is free to toss your request into the trash. 

I don't think you will get everything you are asking for. For debt validation all the CA needs to provide you is a billing statement from the OC.

A collection agency shouldn't have insurance billing records to "prove" your insurance was billed correctly, you need to get that from your medical provider billing department. 

[Anonymous]

The provider, to my understanding, missed the billing date of one year in the contract with the insurance company.  The bill was rejected by the insurance for that reason.  The OC, did not to our knowledge even bill Medicare.  A contributor here had said something about Medicare's CSM or CMS and to address that, something with a timely billing. Our insurance company told them on this they had to 'eat' the cost because of their own error.

[Cowboys4Life]

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@Anonymous wrote:

The provider, to my understanding, missed the billing date of one year in the contract with the insurance company.  The bill was rejected by the insurance for that reason.  The OC, did not to our knowledge even bill Medicare.  A contributor here had said something about Medicare's CSM or CMS and to address that, something with a timely billing. Our insurance company told them on this they had to 'eat' the cost because of their own error.

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MOST of what you demanded is not required under the FDCPA for any debt let alone medical debt.  It is NOT a HIPAA violation for them to request supporting documentation from the provider to send you in response to your DV letter.  As long as the collection agency has an active business relationship with the provider then medical information can be sent back and forth between you and both entities under HIPAA. 

Your insurance company means they have to eat it on insurance reimbursement.  YOU still owe for the care.  Get a copy of the financial agreement you signed with the provider.  I guarantee you it says if any carrier does not pay you are required to.  For the future if after 60 days the provider has not filed a timely claim, file your own and get it started so you don't lose out on using your coverage.

[Anonymous]

I would not send that letter. First its very aggressive and you are not gonna get anywhere with the debt collection agency because as far as they are concerned they didn't do anything wrong, you did. I work in Healthcare and now doing billing and authorizations. Lets start with the medical provider, that office didn't break HIPPA sending you to collections, its not a breach of your privacy. On another note the collection agency has no medical records for you period they aren't equipped to handle it nor would they want too, they are only being hired to collect on behalf of the medical provider. All the debt collector can tell you to verify the debt is the name of the Medical Provider or Hospital System, Date of Service, and Amount owed, if you ask for all the verification the debt collector will send a request to the medical office asking them to send it to you in the mail, the debt collector would never see your records. It is more likely that after they tell you where its from and for what DOS and Amount you would then need to call the provider and find out exactly why you were sent to collections and see if there were any errors with how it was billed. 

Next - you are right there is a timely filing with CMS which is 12 months from Date of Service or the service will automatically get denied after that threshold and the insurance has no obligation to pay it, but that threshold also varies . And while partly true that if they didn't bill it out you can make a case to the provider saying that it is uncollectable because they had several months to get it paid there are other problems, when you go to any type of doctors office, medical clinic or hospital they usually have you sign their financial disclosure which will state "I understand and agree that I am financially responsible for all deductible amounts, co-insurance, non-covered services, or services deemed  as "non-medically necessary" by my third party insurance carrier" They will also have the disclosure if you fail to pay that you will pay for resonable attorneys fees and or collection fees if its past due. If the service was denied and they appealed it they can still technically collect from you, if they didn't bill it out they should not be billing you. 

From your post it seems like you know where its from, you need to call their billing and find out what exactly happened with your claim see if they billed it out at all or if it was denied, if you have a secondary insurance see if they sent the cross over claim to them, and if they didn't bill it then make the case to the office to have you removed from collections because you had 12 months to file a claim and you didn't. But the medical office sent an overdue account in their system to collections but they do not have any of your medical information so definitely not a HIPPA issue, they only have the details on the whats owed and from who and thats all they have to verify. 

[gdale6]

What you have here is a cause of action against the OC for their incompetence. I would just send them an ITS letter (Intent to sue) if they dont write it off and cease collections actions immediately.

[Anonymous]

I rethought this whole process out of what to do.

I found a number to get to the management of OC's corp office.  I was then given the Directors direct line.  I left a vm. A billing supervisor called me back and with the little information I had available to me, she said give them until Monday to get this figured out. The superviser called me back within 45 minutes as she found 10, yes 10 accounts and they were ALL not billed because they didn't have billing information on that sheet. She also said if they would have looked at the cover sheet, they would have seen ALL of the insurance, Medicare and VA information on billing. 
They were pulling this off the credit reports and as required, because they made the mistake of not billing in a timely manner would be discharging the bill at their expense. 
Thank you for your input as it made me rethink my what to do and it worked out perfectly for me.

Have a great day!

[OmarGB9]

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@Anonymous wrote:

I rethought this whole process out of what to do.

I found a number to get to the management of OC's corp office.  I was then given the Directors direct line.  I left a vm. A billing supervisor called me back and with the little information I had available to me, she said give them until Monday to get this figured out. The superviser called me back within 45 minutes as she found 10, yes 10 accounts and they were ALL not billed because they didn't have billing information on that sheet. She also said if they would have looked at the cover sheet, they would have seen ALL of the insurance, Medicare and VA information on billing. 
They were pulling this off the credit reports and as required, because they made the mistake of not billing in a timely manner would be discharging the bill at their expense. 
Thank you for your input as it made me rethink my what to do and it worked out perfectly for me.

Have a great day!

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Congrats!