Turned over to collections for medical bill - advice needed!
 

So I received a letter in the mail about a month ago from a radiology provider (collection agency) - demanding payment for a CT Scan done in 2006.

Prior to this - they had turned me over to Ace Adjustment in about 2007. I went through several phone calls with them and finally said I would pay even though I didn't think it was right or legal - according to their contract with my health provider at the time. They were checking on that and never heard from them again.

NOW, they are back demanding payment of $236 or they will . . . I don't know what.

Called my old Health Carrier (Coventry) again and was advised (again) that the Provider had billed them incorrectly and that is why the claim was denied. Had the provider put the correct code on the bill - it would have been paid. The provider can re-bill but would have to show proof that they re-billed in a timely manner way back when. Which they did not. Health carrier says provider should not be pursuing me personally for their billing mistake; I am not responsible.

I had this same conversation with Ace Adjustment Bureau back in 2007. And I thought they had dropped it. Now, 4 years later, here comes another collection agency.

I called them and told them the same thing. They say it's too late to re-bill but will pass my comments onto the provider.

Should I just pay the damn thing? It really makes me mad that these two providers could not get it together and now I'm expected to pay out of my pocket for a covered procedure when I was paying $$$$ for health insurance at the time.

But I don't want to screw up my credit rating either.

Wow, that sucks. And it's not that uncommon, unfortunately.

I think it's up to you whether or not it's worth the hassle. There is some chance that they may come after you again in 5 years even if you DID pay it, because the paperwork may get lost, etc. In any case, I would write a letter to all three credit agencies with what you've written here. Your letter can be appended to your file.

Any conversations you have, document thoroughly, and keep them organized. Record who you talked to, dates, etc.

Unfortunately it is happening more and more w hospital business offices. They "sell" outstanding bills to collection agencies, even if there is a current bill discrepancy going on between pt, ins co, and hospital. Years ago, this would not happen, but today, the hospital does not want to carry the outstanding money owed and put employee time toward the dispute. I really think this practice is not the correct thing to do to pts who get caught in the middle between a hospital billing/coding system and an ins carrier. After a certain period of time if the bill is not paid, they will sell the debt; regardless of whether a pt has called, disputed the bill and taken steps to resolve the matter. :tongue4: to current hospital billing practices!

Pull your credit report from all 3 credit bureaus and file a dispute with the collection agency. If they can't prove you owe the debt they delete from your credit report with in 30 days. By prove I mean they have to provide you with a written document with dates and signatures and such. You'd be surprised how many can't...

My Hd racked up over 100,000$ in medical bills when we were hit by a drunk driver in 07. We get letters almost every day and it is ordered by the court that the lady has to pay them but where she is in jail and has no job ect...she doesn't send us the money to send them...so we are stuck ...My hd refuses to pay them and we have sent the agency's the court documents they just say for us to pay them and keep the money when she sends it ....so...needless to say it has put a huge dent in our credit score...but that's about it.

I would call the provider and ask them to rebill the collection agency's won't usually do that. I worked in insurance for 33 years and we overturned the timely filing rule all the time. I even think most contracts read if other bills related to the same illness or injury were filed on time then they will pay. I would keep fighting with the insurance company and go up the chain of command. They don't like letters to the president or complaints to the state insurance dept. I would also call the provider and tell then if they had billed the correct code originally this would not have happened and ask them to call off the collection agency.I think it's worth trying even though it is so frustrating. Good luck. Also, be firm but not nasty. Good luck

Thanks guys,

I took all your advice and called the agency. I then sent them a letter confirming our conversation and the information received from the health carrier (they billed incorrectly). I advised of my prior conversations with Ace Adjustment (years ago!) and the steps I took to resolve. I advised of my current conversation with my health carrier and what they said. I provided all the current contact information for my heath carrier at the time.

I copied the original Provider, and my health carrier. I asked them to add this to my file.

I can't believe how much time I've spend on this. But they have really made me mad. I pay a fortune in insurance premiums (don't we all) and the provider screwed up and now everyone wants to put me in the middle.

Thanks for the advice!

That provider had a contract to only bill you the contracted fee, less any payments made by the insurance company. Ask your old carriers to send you the EOB denying the charge - front and back copy - and send the bill collector a copy with a letter demanding they abide by the terms of the contract they signed and send a copy to the network they and you used to be contracted with. Then write the network and complain and ask them to investigate breach of contract with this provider, with a copy to the provider and the insurance company. When they signed the contract, the provider had to agree to submit bills in compliance with current acceptable billing practices or to bill as directed by the contract - apparently they did neither so they are wanting you to pay anyway, despite their failure to abide by proper billing requirements. Go after them and keep copies of everything in case you have to refight this battle further down the road.

P. S. Be sure to send copies of collections letters to all parties with your demands and complaints. Do not accept phone calls from them, request the contact you only in writing so you have a record. If they do call, answer it and report that you are recording the conversation and keep a copy on CD to send with any complaints.

What a nightmare! I think a similar thing happened to me. I got in a car accident a few years ago, and I reported to AAA. It was not my fault. The lady admitted she was at fault. AAA said I could go to a chiropractor for adjustments bc my back was hurting. I guess AAA didn't pay them, bc they started calling my mom. (I put her down as emergency contact). I had my number changed since then, but not my address. Not once did they send a letter. Instead they started having lawyers call my mom's house. She doesn't answer he land line, so she has not spoken to them, but she did tell me what messages they were leaving.

Well since my credit has already gone to poop, and I have no checking acct or paychecks, I don't really worry about it. I hope you have a better outcome.

Thank you. I remember my insurance company telling me something like that the first time around - about the contract they have with providers.

But this is an ancillary provider (radiologist) so. . . hmmm. I'm going to ask my insurance about that.

Big insurance carrier on one side; big Provider on the other - and lowly me in the middle.

You can refuse to pay- for such a low bill ($236) chances are the collections agency will never turn it over to their legal department. However, it will start to affect your credit and IF they did choose to eventually put it in legal status they could eventually take you to court, levy your bank accounts, garnish your wages, etc. I had a similar thing with a medical bill where it kept getting bounced back, insurance should have paid, kept saying it was billed wrong, etc- finally I just gave up and paid it because I didn't want it to get sent to collections and affect my credit.

Well, that will be my next step. But I've prepared the letters and they are going out!

If push comes to shove, I'll pay. But I'm going to push a little first.

He's likely still contracted as most providers won't refer out of network per the contract so whoever referred you for the tests agreed to refer in network unless there are no network providers who can provide the service. Check with your former network and see if that provider was inn(in-network). Ancillary providers have contracts too oftentimes.

If it was out of network(oon), you still should not have to pay due to their error in billing. A nice letter to the provider stating that by not billing correctly and allowing payment to be made by your insurer, they have caused you harm and deprived you of the benefits your insurer would have paid but for their mistake. In that event, the harm is done to you and you did nothing wrong and should not have to financially cover their mistake. Send copies to your state Attorney General, Insurance Board, Department of Labor (if an employer self-insured plan). Let the world know by copy what they did to you and I'll bet they will stop pushing this. Ask for a letter forgiving this debt since it is owed solely due to the provider's error and through no fault of your own.

If all else fails, I suppose you could call your State Insurance Commissioner.

[QUOTE=yorkietalkjilly;3646861]He's likely still contracted as most providers won't refer out of network per the contract so whoever referred you for the tests agreed to refer in network unless there are no network providers who can provide the service. Check with your former network and see if that provider was inn(in-network). Ancillary providers have contracts too oftentimes.

If it was out of network(oon), you still should not have to pay due to their error in billing. A nice letter to the provider stating that by not billing correctly and allowing payment to be made by your insurer, they have caused you harm and deprived you of the benefits your insurer would have paid but for their mistake. In that event, the harm is done to you and you did nothing wrong and should not have to financially cover their mistake. Send copies to your state Attorney General, Insurance Board, Department of Labor (if an employer self-insured plan). Let the world know by copy what they did to you and I'll bet they will stop pushing this. Ask for a letter forgiving this debt since it is owed solely due to the provider's error and through no fault of your own.[/QUOTE]

Ooh, I'm loving this wording! I can see a second letter going out next week containing all of this with the request for the letter forgiving the debt.

make whatever payment you can reasonably afford, once they accept three payments of that amount, they have to continue accepting it.

gonna make an enemy or a lot here but here goes:
I work for a call center for a company that supplies er physicians all over the country. So I talk to people about their er dr bills 5 days a week. I am wondering about something and just some thoughts about medical billing.,

Did you talk to the company before it went to collections? That is the time to ask for any review of possible mistakes in the billing. If insurance denies it for a coding error, the insurance needs to tell the medical group what they think wrong code is or we do not know. If the eob sent to us by the ins just says service denied or not covered then we have to send it to the pt. It is up to the pt to follow up with the ins. We can only bill it, can not make them pay.

Services were provided to the pt, it is the group's job to bill the ins with info provided. it is up the pt to make sure we have the correct info. If ins says not covered, it is between the ins and the pt.

If you ever suspect there is a coding error, ask for the coding to be reviewed. Med grps will do this. errors are made. but you have to ask while they still have the acct. If you get a bill do not assume that ins will take care of it. Call the first time you get a bill. We get calls every day from people who are mad their acct went to collections. We tell them the dates the bill went out to them(usually 4 times ). they say i thought ins was taking care of it. Call at the first bill.

If you need to ask your insurance to call the grp that is what you pay them for. If the bill has went to an outside collection you have to talk to them as the original biller no longer has the acct. Sometimes the ins makes mistakes too.

what code are they disputing? again it may have been coded correctly but the ins processed it wrong. When did you first talk to the provider about a possible problem with the billing?

Sorry everyone. I get so frustrated with people arguing with me about taking responsibility for the bills. Not saying this is the case here though. I even get cussed at when asking for some to provide the ins info.

To my way of thinking, the billing service/provider should do due diligence and check the denial EOB they got back for patient info/insurance errors in a timely fashion. Apparently they even failed to do that in a professional manner. So many providers won't "work" their denial EOB's and just try to pass the balance off to the patient. If the provider wanted their money, they should have done their due diligence at the time and checked all of that when the payment was denied.

We had something similar happen to us from my DH's first marriage. They kept sending us bills 20 years later. I finally got sick of it and consulted a lawyer. Well, that did the trick. And it only cost me $50. Money well spent in my opinion. Haven't heard from them since and it is not on our credit. My lawyer said you would be surprised how many people just pay it. If you have a lawyer, you might give them a call and see what your rights are.

Yes, I did talk with both when all this started (years ago) and thought all this was settled long ago. Unfortunately, this was all over the telephone and I have nothing in writing from my initial calls to the insurance carrier. This time around, it will all be by mail.

I'm frustrated with both the Provider AND the insurance carrier. I paid thousands of dollars for insurance coverage and resent having to pay for a covered service because the Provider failed to bill correctly or the two are two lazy to communicate and it's just easier to bill me.

I just bought a new house last year - so my credit rating is good - and I'm not known for NOT paying my bills.

I understand your point; but I consider myself to be a reasonable person. I will argue the case to the best of my abilities; and while I work with attorneys every day - would probably not involve them in something this trivial. Ultimately, I only have so much time to devote to this provider OR my ex-insurance carrier and it could be cheaper for me in the long run - to pay the bill.

We'll see what response I receive and move forward from there.

Thank you for your insight from the 'other side of the desk' so to speak!