Need possible legal advice on how to proceed with medical billing error/collections
07-24-2017, 09:46 AM
Earlier this year I had to go to the ER. I was treated and paid my insurance copay upon being dischared. About 2 weeks later I received 2 bills regarding the ER visit, a physicians fee for $15 and a bill from a radiology company for almost $500. This made no sense to me since according to my insurance policy once the copay is given all services rendered in the ER should be covered 100% and have been for prior visits. Upon trying to find out what had happened everything went downhill from there.
For starters, calling both the physicians fee place (PFP) and radiology company (RC) was a headache. When asked why I was being charged when everything should have been 100% covered, RC told me the insurance had rejected the claim and PFP told me I was responsible for $15. I called my insurance directly to see why I was being charged. Apparantly there had been some policy changes and while their Explanation of Benefits packet states that ER visits were 100% covered, apparantly there were still some services that now had co pays ($15 for each specialist seen) according to the new policy. While speaking to the insurance representative, she also told me that she never received a claim from RC but regardless I owed them $15, not $500. She then did a 3-way call between her, RC, and myself. The correct forwarding information was given to RC as well as rechecking all insurance info. Everything looked clear and I was told to wait for another statement from RC for the correct $15 amount owed. About 3 weeks later I get another statement from RC, still for $500.
I was annoyed at this point because this was now my third time contacting these people and they still kept screwing up my claim. They told me that my insurance info had been wrong, which was false because everything matched the info on their statement. They said they would send refile the claim again with the correct info to the insurance, again. As you guessed it they continued screwing up.
At one point RC sent a statement threatening to send me to collections if I didn't pay the $500. I called the insurance again and was told that they had never received any claim from RC. Another 3 way call was done, it was discovered that they, RC, somehow had been screwing up the spelling of my name and that it wasn't matching the insurance's database records on file and that is why my claim kept being rejected. After confirming all information was correct, I asked the RC rep if I had been sent to collections yet, she stated I had not and that she would issue a callback notice to the collections agency just in case.
About 2 weeks later I receive a letter from the collection agency demanding I pay the $500. Which brings us to now. How do I go about fighting this and getting my credit cleaned and this statement corrected? I have recorded conversations of every phone call made and have names of people I spoke with. Any advice you guys can give me would really help.
For starters, calling both the physicians fee place (PFP) and radiology company (RC) was a headache. When asked why I was being charged when everything should have been 100% covered, RC told me the insurance had rejected the claim and PFP told me I was responsible for $15. I called my insurance directly to see why I was being charged. Apparantly there had been some policy changes and while their Explanation of Benefits packet states that ER visits were 100% covered, apparantly there were still some services that now had co pays ($15 for each specialist seen) according to the new policy. While speaking to the insurance representative, she also told me that she never received a claim from RC but regardless I owed them $15, not $500. She then did a 3-way call between her, RC, and myself. The correct forwarding information was given to RC as well as rechecking all insurance info. Everything looked clear and I was told to wait for another statement from RC for the correct $15 amount owed. About 3 weeks later I get another statement from RC, still for $500.
I was annoyed at this point because this was now my third time contacting these people and they still kept screwing up my claim. They told me that my insurance info had been wrong, which was false because everything matched the info on their statement. They said they would send refile the claim again with the correct info to the insurance, again. As you guessed it they continued screwing up.
At one point RC sent a statement threatening to send me to collections if I didn't pay the $500. I called the insurance again and was told that they had never received any claim from RC. Another 3 way call was done, it was discovered that they, RC, somehow had been screwing up the spelling of my name and that it wasn't matching the insurance's database records on file and that is why my claim kept being rejected. After confirming all information was correct, I asked the RC rep if I had been sent to collections yet, she stated I had not and that she would issue a callback notice to the collections agency just in case.
About 2 weeks later I receive a letter from the collection agency demanding I pay the $500. Which brings us to now. How do I go about fighting this and getting my credit cleaned and this statement corrected? I have recorded conversations of every phone call made and have names of people I spoke with. Any advice you guys can give me would really help.