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Need possible legal advice on how to proceed with medical billing error/collections
#1

Need possible legal advice on how to proceed with medical billing error/collections

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.
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#2

Need possible legal advice on how to proceed with medical billing error/collections

Medical billing and collections are a complete mess. For this specific situation your best advice might be to make a burner account over on credit boards and see if they have any advice, they do this all day.
https://creditboards.com/forums/index.html?showforum=39

https://whychat.me/hipaadisp.html

https://whychat.me/GUIDE%20HIPAA%20PROGRAM.html

https://whychat.me/GUIDEBOOK.html
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#3

Need possible legal advice on how to proceed with medical billing error/collections

I spent about six years back in the day as a medical claims payor. This is fixable.

Confirm that the claim has been received by your insurance company. Ask for the claim number for your reference. They will have a set number of days in which they must pay or deny the claim. Ask about this.

It sounds like your main problem is with the RC. Get with the person there who you last spoke to about collections. Let them know either the date your insurance company received the claim, or let the RC know if the claim has not been received at all. Remind the RC that the delay was due to an error on their end as to the spelling of your name. While you have them on the line, verify all the demographic information they have on you (name, address, contact info) so they cannot use this excuse again.

If the insurance company does not have a claim at this point, tell the RC that they must furnish you with a copy of the bill so that you can file it yourself. They might object to this, as many service providers want to file the claim themselves. But I would say they blew their chance by now. If the insurance company does have the claim, let the RC know the received date and the payment turn-around time the insurance company follows. Ask the RC to put all of this in their notes, including when they should expect payment based in the timeline info discussed above. Insist that they revoke their collections action until such a time as you reasonably expect the claim to be paid. Let them know that you will follow up on this conversation by writing this entire timeline down in a letter, including the agreed upon hold on collection action. Ask for the name of the billing supervisor or manager that you can send the letter to. In the letter, mildly mention legal action if the agreed upon collection hold is not honored. Look up the address of the Department of Insurance in your state and address your letter to both the RC and the DOI. Get that letter in the mail the following day. Insurance companies who received complaint letters are required to escalate the case up the ladder.

The bottom line is, you might have to do some hand-holding to walk this claim through. Always be prepared to do this when it comes to insurance. And have all your ducks in a row should you have to appeal the claim. Good job on recording calls and contact names.
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#4

Need possible legal advice on how to proceed with medical billing error/collections

Quote: (07-24-2017 10:52 AM)frozen-ace Wrote:  

Medical billing and collections are a complete mess. For this specific situation your best advice might be to make a burner account over on credit boards and see if they have any advice, they do this all day.
https://creditboards.com/forums/index.html?showforum=39

https://whychat.me/hipaadisp.html

https://whychat.me/GUIDE%20HIPAA%20PROGRAM.html

https://whychat.me/GUIDEBOOK.html

Creditboards are the Rooshers of debt.
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#5

Need possible legal advice on how to proceed with medical billing error/collections

Quote: (07-24-2017 09:54 PM)Darth Publius Wrote:  

I spent about six years back in the day as a medical claims payor. This is fixable.

<SNIP>

The bottom line is, you might have to do some hand-holding to walk this claim through. Always be prepared to do this when it comes to insurance. And have all your ducks in a row should you have to appeal the claim. Good job on recording calls and contact names. [/align][/align]

Excellent advice here from Darth Publius. Remember also to always ask for a supervisor and be as professional as possible. Losing your cool, yelling, telling them they're idiots is not going to get you anywhere. If you really are stonewalled, reporting them as Darth Publius mentioned is one avenue of recourse as well as letting them know that because they admitted fault on their end and STILL have not completely resolved the issue, including sending you to collections in error (by their own negligence), that you are demanding that they fix the issue and notify you in writing of what they accomplished, including sending a notice to collections that they copy you on absolving you of the debt. If not, you can take them to court and you'll win easily.

Be thankful that your own insurance company was not the one screwing with you. That happens plenty too. Insurance companies of all types are in the business of NOT paying. Remember that. As DP said, great that you recorded information. The more you have them record on their end and the more you record on your end (including escalating the issue to a supervisor and still not getting traction) the better. Another additional avenue is contacting the office of the VP of customer service or billing (or equivalent) at the medical institution via e-mail and written letter demanding that they resolve this issue and letting them know that their staff has admitted fault and not corrected the issue and you are at your wits end and can they please help you.

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#6

Need possible legal advice on how to proceed with medical billing error/collections

Quote:Quote:

If you really are stonewalled, reporting them as Darth Publius mentioned is one avenue of recourse as well as letting them know that because they admitted fault on their end and STILL have not completely resolved the issue, including sending you to collections in error (by their own negligence), that you are demanding that they fix the issue and notify you in writing of what they accomplished, including sending a notice to collections that they copy you on absolving you of the debt. If not, you can take them to court and you'll win easily.

I was still unclear before on whether this was an option or not. With legal fees and everything else I wasn't sure if a lawyer would take a case over only a $500 amount. Thanks for confirming.

Quote:Quote:

notify you in writing of what they accomplished, including sending a notice to collections that they copy you on absolving you of the debt

This has been the biggest challenge for me as I've requested more than once with RC that they send me a written notice of what had been discussed on the phone and what they stated they were going to do but they either ignore, say yes to shut me up, or play dumb when called on their bluff.

If after everything is said and done and I've tried every other recourse by being civil but nothing is being resolved how can I proceed playing hardball with an attorney? What type of lawyers handle these sorts of cases? I keep getting conflicting/contradicting information online so I really am unsure of where to start looking just in case.
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