medical debt reporting

The Date Opened as 8/2006 can be correct (date CA took account), what needs to be on your report is Date Of Last Activity (4/2005) or Date First Major Deliquency Reported (4/2005).

Try disputing based upon DOLA or DFMDR......
Also, did you request any validation upon receipt of 1st notice from CA?
Is this paid?

 

Any insurance claim issues?
Is the doctor (the medical provider) in-network, covered by a contract with your insurer?
Did the doctor file a claim with your insurance, did you receive an EOB, and does your patient responsibility match his bill to you?

 

I think your best approach here is to try and get the medical office to "pull" the account back. If you can somehow communicate that you want to pay it only to the medical office, and they can "pull" the account back, then a CA is supposed to delete a TL if it has returned the account to the OC. I don't know if you can convince them to do this, sometimes a straight payment to the OC does this.

Other than that, this is a difficult one. You may try disputing again, but either way I would pay it first, give it time to process, then dispute. For this amount they may not bother wasting the time to verify....

 

If they are "in-network", and did not bill you based on insurer's rates and patient co-pay, then you have a contract violation to force the issue.

Otherwise, is there any other "error"?

 

Ontrack, I'm intrigued by some of your questions; did you ever have any of the "classes"in medical billing. I am just stupified by the billing practice of the medical industry. I was actually shocked years ago when an employee who was going to school for medical assitance, told me about all her classes for just "billing" (and yes it included turning over to collections). I then started asking and was amazed at this.

I ask only because I am truly trying to understand this medical billing practice, it seems unlike anything else in business I've encountered! I know I always feel like I'm on the "losing end" no matter how I approach some of the problems I get with med bills......

 

I just ran into stuff in the school of life. My perspective is perhaps similar to yours, from the point of view of how do you set up business systems to function reliably.

Medical billing couldn't have been set up to create as many errors as it does if it had been designed for that purpose. Patients often become customers under less than ideal circumstances, patient billing information is rushed, accurate identification may not exist, each patient is different, so each service is different, yet for billing it all gets reduced to codes, which can be in error. In a hospital setting, there may be many separate medical providers, all different legal entities, all eventually submitting bills, yet the patient may be in no shape to even be aware of who they are. The hospital may not even know who they provided patient billing info to. Despite billing info submitted once to the hospital, each somehow ends up with a different corruption of that patient name, address, or insurance info. Murphy run amuck.

There is usually a third party, the insurer, but the patient might not receive any bill until after the insurer has responded to the claim, since the patient's responsibility depends on the insurance schedule and patient copay terms. In some cases there is no copay due, and the patient will normally receive nothing, so the patient doesn't even know if they should expect to receive any particular bill.

If the provider makes an error in insurer, or in patient identification or account number, the claim may be rejected, but there might not even be a reply back to the provider. Although correct insurance info might be submitted, it might not be used, old info might instead be used, and nothing happens. It just sits there, until the provider decides they didn't get paid, and some just send it to collection at that point, without even a bill sent to the patient. By the time this happens, 4 to 6 months after they should have received payment, some figure the patient deserves black credit marks for not fixing the problem they may have originated.

On receiving payment from the insurer, the hospital can fail to credit the proper account, since they may be handling billing for multiple physicians, and one physician could be overpaid, another not paid, and the patient could have a net credit, yet an account goes to collection.

On bringing a problem to anyone's attention, it may take weeks, with weekly followup calls, to attempt to get someone to do something and force a correction. Systems are designed to limit access of the patient to full information, and if someone else is assisting the patient in handling the bills, then a whole additional "patient privacy" barrier must be worked around.

All parties pass, or don't pass, information between each other, with no visibility to the patient, who is assumed to not understand any of this. Providers fax a claim to one number, but they should have faxed it to a different number, in a different state. It went into a black hole.

The whole medical community is culturally hierarchical, a pecking order, and if you are not an insider, you are an outsider who cannot comprehend anything. They are the experts, you might as well be a child. Since this is the culture, the attitude even extends down to billing, and hence collections, even though none of them are doctors or nurses, unless an organization actively works to maintain quality. In my experience, teaching hospitals associated with universities tend to have an edge, since some of their professionals are at least aware of the cultural aspects of delivering quality care.

Resolving problems depends on some level of competence, or at least good faith. The best billing organizations realize that the process is inherently error-prone, and have designated problem solvers, with access to different billing systems, to straighten out problems, and their normal billing departments know when to send patients to them. The best insurers also have problem-solvers. The worst, well, you see problems here that should have been solved in a month.

The result is patients, perhaps already dealing with some financial stress from medical costs, then get their credit trashed even if they have insurance and money to pay.

In my view, incompetent billing is as much a part of incompetent medical care as if the doctor had done it. Financial complications can snowball just like medical complications, and financial collapse has medical consequences.