CA and hospital bills - validation?

Your post is confusing. You first say you received an itemized bill from the hospital. Later, you say it's a computer pintout from the company {I assime the CA]. What's the real story. It makes a difference.

 

OK, this is not validation per the FDCPA.
http://www.ftc.gov/os/statutes/fdcpa/fdcpact.htm

Look at 809 a{4}
The validation must come from the oc to the ca who sends it to the consumer. The 2nd paragraph of the Wollman letter makes this distinction as well.
http://www.cardreport.com/laws/fdcpa/ftc-opinion/wollman.html

 

Did you visit the health care provider and expect that aside from applicable co-pays, deductible, or other non-covered/out-of-pocket expenses that the bills would be be covered by insurance? The hospitals statement is only partially correct - you are responsible for any charges that are not covered by insurance. On the other hand, you should not be held responsible for bills not paid by the insurance company if the hospital was negligent in its responsibility to file timely and accurate claims with the insurance company! If the disputed amounts are the result of you not paying applicable patient expenses such as patient co-pay, deductible, or other out-of-pocket expenses then you can stop reading as the rest will not help apply to your situation.

First, you will need to contact the insurnace company and review the claims history for the period (year) in which these hospital bills were incurred. You are specifically checking to see if all claims for service were filed and subsequently paid by the insurance company. My guess is that the hospital or its billing department/service may have either filed inaccurate claims or simply failed to file the claims for your visit in a timely basis (usually within 90-days). You may find that several claims were filed and denied/returned or you may even find that no claim has ever been submitted. Why is this relevant, because despite the hospitals disclaimor, under federal and most states medical insurance reform acts/laws, claims that are not accurate or submitted to the insurance provider in a timely basis becomes the responsibility of the health care provider and not the patient!

If this is the case, then more than likely you will need to involve your states Attorney General - most have websites that allow for filing formal complaints online - as well as consulting a lawyer so that the a letter to the hospital can be drafted that reminds the hospital of the applicable laws that the hospital may be violating in your state as well as to demand that due to the hospitals failure to file accurate/timely claims that they are required to "write off" the debt and immediately recall any and all related collection accounts! You should also continue to pursue the "normal" flow of validation with the CA - I would suggest that you counter their attempt at validation with a demand that the CA produce a claims history documenting that the hospital filed the associated claims with your insurance company. This should keep them busy until such time as you are able to get relief from the Hospital since this is actually the root of the dispute!


Michael