I wanted to ask for for your kind help once again. I owe over $5,000 to a hospital mainly for two visits to the Emergency room. At the time, I did have health insurance. But since I never previously had health insurance, I wasnâ??t familiar with how the rules actually work â?? deductibles, out of pocket expenses, etc. So I mistakenly thought most of the bill would be covered by insurance. Iâ??ve requested and received Explanation of Benefits letters from the insurance company. However, I donâ??t really understand the letters. Iâ??ve called and talked to the insurance company several times on the phone and theyâ??ve briefly explained the letters. But I honestly still donâ??t understand how theyâ??ve calculated what they paid, and how much Iâ??m responsible for. In any case, the hospital sent the bills to a Collection Agency (CA). I received highly valuable advice from this website that was really helpful. Based on the advice I received here, I sent out debt validation letters for the bills. The CA has written back and attached a copy of the bills and all the charges. Iâ??m struggling financially so I havenâ??t been able to pay the premium anymore and Iâ??ve had to cancel the insurance. And I canâ??t really pay the over $5,000 Iâ??ve been charged. Although I donâ??t understand medical terminology, in examining the bills the CA recently sent me, I was able to find two services for which the hospital charged me that they never provided. I also believe some of the charges are simply outrageous, such as (EXAMPLE). I want to dispute the two inaccurate charges and the outrageous amounts. And I also want to work out some sort of payment plan for the balance since there is no way I can pay over $5,000. Iâ??ve contacted the hospital several times, but they are not interested at all in dealing with me and theyâ??ve told me to deal directly with the CA. Given the dire circumstances, how should I try to resolve this matter? It appears I donâ??t have any good options, but is there a strategy that might produce something less negative than the others? I would greatly appreciate your thoughts, ideas and advice. Thank you very much for your kind attention and help!!! Thank you!!! Tom
Once again, thank you very much Mindcrime for your kind attention and time. I donâ??t think I can prove that the two services theyâ??ve billed me for were not in fact rendered. What I do know is this: 1. The hospital did an ultrasound for which theyâ??ve charged $1,192. I had the same ultrasound of the same area of my body done about a year earlier. Since I didnâ??t have insurance at that time â?? and no longer have insurance now â?? I had to pay cash for the service. The medical clinic charged me under $200 (around $180 or so) for the ultrasound. The same ultrasound of the same area of the body was done by the hospital, and on the bill it shows that the hospital is charging $1,192 for this service. 2. In addition to this ultrasound, the bill shows that the hospital charged me for a second ultrasound that they allege they performed on my abdomen on the same day. Theyâ??ve charged $930 for this service. However, the hospital never did an ultrasound on my abdomen. They only performed one ultrasound on another area of my body for which they charged $1,192. 3. Unfortunately, I donâ??t know anything about medicine, and I donâ??t understand medical terminology. So, in all honesty, I canâ??t say that there are other services that the hospital charged me for which they never provided. I think itâ??s more accurate to say that there are many services that the hospital charged me for which I donâ??t understand. 4. Another thing that makes me suspicious is the fact that on another visit to this hospital/clinic, they gave me a holter monitor to wear for 24 hours to monitor my heart activity. Since I never had health insurance in my life before â?? except the 2 years I recently had it with this insurance company â?? I wasnâ??t aware of how the system works (deductibles, out of pocket expenses, etc.). I assumed that most of the cost of the holter monitor service would be paid by the insurance company. The CAâ??s bill shows that the hospital/medical clinic has billed me for two items related to this service: a. â??Holter Record/Hkup/Disc Aâ? $697 b. â??Holter 48 hour Scan Analysisâ? $832 I have two problems with this bill. a. I wore the holter monitor for only 24 hours. So why does the bill show â??Holter 48 hour scan? I have a feeling that, once again, they are trying to pad the bill. b. I remember I paid the hospital/medical clinic around $350 related to this service. But I donâ??t see any adjustment on the bill for the amount I paid. In fact, on the bill the CA sent me, it only lists (a) the amounts charged by the hospital/clinic, (b) the amounts paid by the insurance company, (c) the principal balance remaining, (d) accumulated interest to date, and (e) total currently due. The bill doesnâ??t show the amounts I paid. To be honest, I paid under $1,000 during that year but still, I would think that the bill should also list and factor in these payments. In any event, there is no way I can pay the more than $5,000 the CA says I owe so I want to work out some sort of payment plan. But I also want to see if I could get some adjustments for the incorrect charges. Iâ??ve contacted the hospital several times, but they are not interested at all in dealing with me and theyâ??ve told me to deal directly with the CA. It appears I donâ??t have any good options, but is there a strategy that might produce something less negative than the others? Also, how much time do I have to respond to the CAâ??s bill/debt verification letter? I would deeply appreciate if you could kindly provide me with any advice or guidance. Thank you very much for your kind assistance. I really appreciate your thoughts and help! Tom
Are all the things you are listing on the bill that the CA sent to you? If so, they aren't supposed to have any information about the specific services rendered. If the hospital sent it due to the request of the CA that's one thing... But the CA isn't supposed to have access to any of your personal information regarding procedures, diagnoses, etc. Google the HIPAA process, you may be able to get this taken care of that way if in fact that itemized bill did come from the CA
Hello Jmc Thank you for your kind response. Everything was sent to me by the CA. I had also heard that the CA’s sending me the bills listing details regarding procedures, diagnoses, etc. may be a violation of the HIPAA. However, I recall that Jam237 mentioned in a past post that in the Privacy Policy, the hospital will more than likely have a section allowing disclosure of this information for “billing and collection purposes.” I’m assuming that the hospital must have this special exception for billing and collection purposes. Thank you once again for your time and thoughts. I greatly appreciate your help. Tom
I would contact the hospital and ask them for a copy of their privacy policy. I actually brought my husband to the hospital last night and read through the privacy policy they gave us and other paperwork and it was pretty vague about collections. You may be able to use that as leverage.
Thank you so much, Jmc. I will definitely contact the hospital, get a copy of their privacy policy, and read it carefully to see if there are any exceptions for collection purposes. Thank you so much for your kind help! I greatly appreciate your assistance! Tom
I'm in the process of determining what's a HIPAA violation and what isn't. Waiting on a response from the DHHS Office for Civil Rights. Tomm: There is no time limit as to when you can respond to the CA's LTR, typically they'll give 30 days before taking another step (if they even decide to). Did you ever look at the link I sent about how medical providers have to give a minimum of 120? or 90? days (can't recall off top of my head) before collection procedures? And if you did, did you use it to try to negotiate at least one of these accounts back into the hospitals hands (one was from Feb, right?) As far as the charges for services that never really occurred. I think you need to do everything in writing from now on to the hospital (mail CRRR or fax w/conf.) I'm not familiar much with medical services and what you can request, but I would think you could request proof that these services WERE in fact performed. If a hospital was doing this to an insurance company (billing them), this would be considered insurance fraud.
Hello JMC. I wanted to let you know that I checked the hospital’s “Notice of Privacy Practice.” It says “We may use and disclose health information about you so that the treatment and services you receive…such as an ambulance company, may be billed to and payment may be collected from you, an insurance company or a third party.” Based on that statement, I think they may not have violated any HIPAA laws by providing detailed information regarding the services they rendered to the CA. On the other hand, the Notice of Privacy Practice I received is recent and has listed an effective date of March 1, 2013. I wonder if this statement existed in their past Notices back when I was treated in October and December 2012 and January 2013. I tried to find copies of the past Notices but I wasn’t able to find them. In any case I thought I’d let you know what I found. Thank you once again for all your time and kind help! Tom
Hello Mindcrime, Thank you very much for your kind help. If you get a response from DHHS’ Office for Civil Rights, I would greatly appreciate it if you could let me know what they say. It would be very helpful to know what constitutes a violation of HIPAA laws. Can you kindly let me know where I can find the link regarding how medical providers have to give a certain amount of time before continuing with collection procedures? I was wrong about the dates of the medical bills. I had wrongly assumed that one of the bills related to services the hospital provided in February 2013. Sorry about the mistake. I’ve been to so many doctors and hospitals due to my deteriorating health and received so many different bills and I don’t understand much about insurance - first time I’ve had insurance in my life – so I’ve been really struggling to figure things out. The bills actually are from October 2012, December 2012 and January 2013. I don’t know if I can negotiate any of the bills back to the hospital. I’ve called the hospital several times and they always tell me that the matter is no longer in their hands and I need to talk to the collection agency. I’ll try once again to see if I can deal directly with the hospital. I will make sure to put all communications with the hospital in writing. Thank you once again for all your kind help. I really appreciate it! Tom
It's actually a family member going through the HIPAA issue, but I will report back when there's an update. Here's a good link that explains it all very well: http://healthconsumer.org/cs056HospitalBilling.pdf Your Dec 2012 and Jan 2013 bills would have still fallen under the scope of this law, if the following applies: "What bills are covered? AB 774 only covers bills from the hospital, not from other providers who may bill for services provided in the hospital." Only you know what bills are what in your case. It may not be that all of them are covered under this rule. "How long must a hospital wait before submitting a bill to collections? Hospitals may not report patients who are not covered by insurance or who have medical costs that exceed 10% of their family’s annual income to a credit reporting agency or commence a lawsuit prior to 150 days after the initial bill." "Hospitals cannot send a bill to a collection agency or other assignee if the patient is attempting to qualify for financial assistance, negotiate a payment plan, or is making regular partial payments unless that entity complies with AB 774." I suggest reading up on this, and then doing all further correspondence in writing, CRRR. In your letter be sure to include all dates you made contact with the hospital billing department between the date of the bill and now (many, if not all of those dates will fall under the 150-day mark) and that the hospital violated AB 774 by submitting the bill to collections so quickly. Any of your hospital bills that fall under this should be immediately removed from collections and the hospital will need to work with you to set up a payment plan.
While I don't know as much about credit woes, I do know a lot about healthcare and HIPAA. You need to get your medical record from the hospital. Now. If you are being billed for services that were not rendered, that is a big big big no no. You were given a revised privacy notice because HIPAA was amended to include HITECH this year. However, theirs is incredibly broad and they will probably get sued at some point.
Try going above everyone at the hospital to the President/CEO, and then let their office work you down to the highest person there that you can talk to.
Agreed. You can also try to figure out who their chief compliance officer is or chief privacy officer-those people would be great to contact with issues like this.
Thanks again, Mindcrime, for all your time, attention and invaluable help! And thank you so much for the link to the document titled “Limitations on Hospital Billing and Collections.” I now realize that you had sent this document to me before but, unfortunately, I never read it and eventually lost it. I did read it this time and found out that the document is about AB 774, which lists regulations that apply low-to-moderate-income Californians. The information is really awesome! At first, I thought the material in the document does not apply to me and applies only to uninsured patients. However, I noticed that the document mentions that AB 774 also applies to: “Patients with health care coverage under 350% FPL (Federal Poverty Level) whose annual out-of-pocket costs exceed 10% of the patient’s family income.” Since I am single with no family members, and my income last year was around $10,000, I think my income is under 350% of the Federal Poverty level. (For a household size of one person, the 2013 Federal Poverty Guidelines lists an annual income of $11,490 as being equivalent to 100% of the Federal Poverty level). Although my income last year was around $10,000, some of that income was interest income. Could that disqualify me from being considered for financial assistance given that I have some savings in my bank account? Since I haven’t been able to work over the past 2 years due to health reasons, my savings is rapidly declining. The section you quoted from the document regarding how much time a hospital should wait before submitting a bill to collections is great: “Hospitals may not report patients…who have medical costs that exceed 10% of their family’s annual income to a credit reporting agency…prior to 150 days after the initial bill.” I believe you had pointed this out to me in an earlier post, but given my serious difficulties in concentrating and understanding material, I never understood how relevant it was. Thank you!!! I think at least two of the bills were sent to the collection agency prior to 150 days. Unfortunately, I don’t think the second quote would apply to me. “Hospitals cannot send a bill to a collection agency…if the patient is attempting to qualify for financial assistance, negotiate a payment plan, or is making regular partial payments unless that entity complies with AB 774.” The bills were sent to me by mail (3 times) and given my mother’s cancer and the time I was spending taking care of her as well as several other problems, I ignored the bills. I thought that the hospital would eventually call me over the phone once the bills were way past due, and I could possibly work out something with them at that point. However, after the bills were mailed three times, the hospital sent the bills to the collection agency. So, unfortunately, I was not “attempting to qualify for financial assistance, negotiate a payment plan, or…making regular partial payments.” However, after the bills were sent to the collection agency, I did contact the hospital several times to see if I could work out a payment plan but the hospital told me that I would have to deal directly with the collection agency. I made all those contacts within 150 days, so maybe I can use those attempts as evidence that I was “attempting to…negotiate a payment plan.” You mentioned that any hospital bills that fall under the 150-day mark could be removed from collections and the hospital would have to work with me to set up a payment plan. Should I write to the hospital and request that they remove the bills from collections, or should I write directly to the collection agency, or both? Thank you once again for all your help! I really appreciate it! Tom
Thank you very much NikNak for your kind attention, time and help. I know that I was billed for at least one service that was never performed. You mentioned that I need to get a copy of my medical record from the hospital. Do I need to get a copy of my medical record in order to verify that they charged me for a service that was never rendered? Do I have any specific recourses if that was done? Thank you once again for your kind assistance. Tom
Hello Jam, Thank you once again for your kind attention and time and for your help. I did write to the CA and mentioned that the information they provided was personal and confidential and that their access to such protected information appears to violate HIPAA laws. I’m hoping that would give me some leverage. Thank you for your kind advice. Tom
Hi Jam and NikNak, Thank you both for your kind help. Jam: You mentioned that I should contact the President/CEO Office and work my way down to the highest person at the hospital that I can talk to. Once I get a hold of this person, should I talk to him or her regarding taking back the bill from the collection agency and allowing me to work out a payment plan. Or complain about the fact that they disclosed personal and confidential information about me to the collection agency? Or should I raise both issues? Niknak: You mentioned that I should try to speak to the Chief Compliance Officer or Chief Privacy Officer. I am assuming that I should complain to them regarding their disclosing personal information to the collection agency? Is that correct? Thank you both once again for your kind assistance. Tom
