Hello, I wanted to see if you could kindly help me with regard to two bills I have received from a collection agency. Any assistance you can provide would be deeply appreciated. I owe money for medical services since I went to the hospitalâ??s emergency room twice for heart problems. I stayed at the emergency room/hospital for about 4 hours or so the first time, and I stayed at the hospital overnight for observation on the second visit. The original hospital bill was about $8,000. I have health insurance through Anthem Blue Cross and apparently the insurance plan covered about $3,500 of the bill. However, the collection agency claims that I am responsible for about $4,500. Since I was taking care of my mother who is 88 years old, suffers from cancer and recently had heart surgery, unfortunately, I didnâ??t contact Blue Cross to understand how much of the bill they should have paid, and I did not contact the hospital to see if they would accept some sort of payment arrangement so I could pay the amount I owe in affordable installments. Unfortunately, except for the last 2 years, Iâ??ve never had health insurance before so Iâ??m having trouble understanding the terms of my health insurance plan. I believe I have already met my $1,000 deductible and a large portion of my out-of-pocket maximum this year, so I think that a larger portion of the bill should have been paid by Blue Cross. I also canâ??t understand the bill sent by the Collection Agency, since the amounts listed by the collection agency do not correspond to the amounts that were billed by the hospital even after taking into account the portions that were paid by Blue Cross. The bill that was sent by the hospital shows a lump sum amount rather than a breakdown of the specific medical services they provided. Would it be wise to ask the collection agency to send me a bill from the hospital that breaks down the amount theyâ??ve billed to show how much they charged for the x-rays, how much they charged for the EKG, how much they charged for blood draws, etc. while I was at the hospital? Perhaps that way I could develop some understanding as to how they came up with the large lump sum amount. I also understand that Blue Cross has a Negotiated Fee Rate (Pre-negotiated Discounted Fees) agreement with this hospital as to how much Blue Cross would pay for each type of service the hospital provides. Would it be a good idea to ask that Blue Cross provide me with a copy of the Negotiated Fee Rate agreement with this hospital in order to verify whether Blue Cross paid the correct and proper amount for the medical services the hospital provided? What are the chances of getting the collection agency to agree to accept a lower amount than what they are demanding right now? Would they agree to payment arrangements so that I can pay the amount due in affordable installments? I would be deeply grateful if you could give me any advice, information and ideas regarding how I could handle this issue. Thank you very much for your kind attention and time! I greatly appreciate your help! Tom
They probably won't provide the fee agreement, but you should receive an Explanation of Benefits (EoB) which should tell you a few things. The total amount submitted, the amount which was APPROVED (under the fee agreement), the amount which you are responsible for under either the co-pay or deductible. The collection agency, I would normally write a letter stating that the amount they are claiming is disputed, in its entirety, as a part of an insurance dispute; and I would request all communications by writing only, at my personal home address. I would also tell the collection agency that you are requesting an item-by-item completely itemized invoice, which also reflects all money received by the insurance company, and all adjustments which they are required to make under their fee agreement with the insurance company.
Sorry to hear about this! I don't think that the hospital can release that information to the CA due to HIPAA laws. They can't release any specific information about your medical records, so it's likely that the CA just got your name, address, and the total amount from the hospital. I'm sure if you contact the hospital they can give you a break down of what the charges were before they passed it along to the collection agency. If the numbers don't add up you can dispute it. Also I would call your health insurance provider and see what exactly they cover or ask them what they covered for that visit. Errors are common. Once you hit your deductible for the year, your insurance company should cover a certain percentage of hospital visits (although all policies are different). They should be able to provide you with details. When did you go to the hospital? It seems like maybe it was earlier this year since you said you thought you had met your out of pocket maximum... If it was maybe you could get the hospital to take your account back from the CA and put you on a payment plan Good luck!
Determine if the CA owns the debt or if the hospital assigned if to them. If assigned, work with the hospital. Like jmc said, if this was within the last year you may have success in getting them to pull the account back and setting up a payment plan. Also, have you called the hospitals financial counselor center/dept? Some (or many?) have these and even if a patient has insurance but is having financial hardship, will reduce the balances up to 80%. I know of someone who has had success in going this route -- working with financial counselor at hospital to not only reduce balance, but when they met their obligation (paid off rest of balance still owed) the hospital agreed to contact assigned CA and delete from reporting. If this debt is not reporting and its merely assigned, now is the time to strike.
jmc, one reason though for demanding it, is that it is a REASONABLE validation for an insurance dispute, and if they can't provide it, they need to cease collection until they can; and that means recall to the party who CAN provide that level of validation, the original creditor. Keep in mind that anything which validates, (a) the amount of the debt (a simple lump sum total doesn't cut it, when there are more complicated issues such as crediting insurance payments, and making contractually obligated adjustments), (b) that this is their account, (c) what the terms of the account are. So, it's a multi-pronged approach, the EoB from the insurance company provides the amount that the hospital bill should have been with the adjustments, and what the insurance company paid; but you need an itemized statement showing what the alleged charges are (to ensure that they weren't charging $500 for an advil - which in some cases wasn't even given, but popped up on the bill, in hopes that the victim wouldn't notice it).
jam I didn't think that it was legal for CAs to have info about your medical records except for the total amount and payment info? I could definitely be wrong. I would assume if you tried to DV the CA they would just defer it to the hospital in which case you would get a breakdown of charges from the hospital instead of the CA. I had read somewhere about when the CAs/hospitals are not following this rule and in that case it opens up a new can of worms where they are violating HIPAA and you can get the debt thrown away. Although not everything you read on the internet is true!
In the Privacy Policy they will more than likely have a section allowing for "billing & collection purposes"
Thank you very much, Jam237, Jmc912, and mindcrime. I really appreciate your taking the time to read my post and being kind enough to provide me with valuable advice and kind assistance. I knew I could find helpful advice here. Thank you so much!!! I wanted to provide a quick update and see if you could provide any further guidance. These bills are fairly recent and this is the first time that the collection agency has contacted me, so I’m assuming that the bills have not yet been reported to any credit bureau. 1. The hospital bills are from January 2013 and February 2013. I thought I had read somewhere that in California, where I’m located, a debtor has 150 days to settle a medical account before the provider sends the bill to a collection agency. However, I was totally wrong. I called the hospital today, and they told me I had only 90 days to pay the bill. Since they sent 3 notices and I did not contact them within 90 days, they sent the bills to the collection agency. I wasn’t able to contact them on time in large part due to my mother’s cancer and heart surgery and the fact that caring for her and trying to earn a living consumes a huge chunk of my time. 2. Since the bills are from about 3 months ago, I asked the hospital if they would take back the account from the CA and allow me to make payments. However, they said they were unwilling to do that and that I would have to deal with the collection agency. 3. Although the hospital sent me the bills – and they vary in amount from what the collection agency is claiming – the amount that was listed on the hospital bills was a lump sum fee rather than a breakdown of the charges. I want to ask the collection agency to provide me with an itemized breakdown of each and every charge rather just a lump sum amount for the emergency room treatment and hospital admission. However, I’ve now learned about HIPAA laws, which apparently protects the privacy of patients. I think that based on the HIPAA laws, the hospital cannot provide the collection agency with confidential medical information about me. So, on the one hand, I want to request that the collection agency provide me with an itemized bill but, on the other hand, can the collection agency obtain this information since I believe if they were to obtain and submit this information to me, that may expose them to liability under the HIPAA laws? Or is this not a relevant issue? 4. According to the hospital, the debt was “assigned” to the collection agency. What is the difference between “assignment” of a debt and “owning” a debt? 5. Would it be wise to request that the collection agency provide proof that they were “assigned” the debt or that they “own” the debt? 6. The collection agency has added on fees and interest to the original bill. Is it true that they cannot add fees and interest to the original bill unless they sue me and secure a judgment? If so, would you happen to know which law or regulation bars them from adding fees and interest to the bill? 6. Based on what I’ve read on this website, I believe I need to send the collection agency a “dispute letter” and a “debt validation letter.” Is there a difference between the “dispute letter” and the “debt validation letter?” Or can you dispute the debt and ask for validation in the same letter? 7. Is there a template or a sample “dispute letter” or “debt validation letter” on this website I could use? I would greatly appreciate any additional assistance you can provide. Your kind advice thus far has been truly helpful. Thank you once again for your time and guidance!!! Tom
Likely, this is true. However do not count on that. I've dealt with CA's that have reported BEFORE contacting the consumer. Actually, you may be right. I did not read the entire article or know how valid this is, however it does point to the 150-day period during which they (patient) can negotiate their hospital payments before their medical bills are sent to collections agencies. http://www.familiesusa.org/assets/pdfs/medical-debt.PDF 90 days from February bill = May 2nd (and that's if it was incurred on Feb 1). If nothing else, this account should not have gone to collections. Go above whomever told you this. They are not the final word. IDK hospitals in CA, but here I know of at least two that do have financial counselors. Another option is to research some 'higher up's' and write letters to them. Assigned means that the OC still owns the debt and that the CA will get a percentage of what they collect on it from them. Own is when the hospital sells the debt, usually for as low as 10 cents on the dollar. I don't believe asking the CA whether they're assigned or they own it in this case will benefit you. If you had multiple CA's coming to you trying to collect on the same debt, then that would start to come into play. Depends on your state laws I believe as far as the CA being legally able to add their own fees. Also the contract you signed with the hospital when you received services should have this spelled out (probably buried in the fine print). You dispute through the CRA's. You send validation letters to the CA's. A DVL is essentially a dispute, but one based on specific language of the FDCPA. (So if you're asking for validation, you're essentially disputing the debt.) If you haven't already, google the FDCPA (and FCRA while you're at it), and do some reading. It will take time, but trust me, it's worth it. The better understanding you have of the laws that protect you the better you can come out of this. There is a Sample Letter forum (before you enter the Credit Talk forum) on the site. There are several sample letters there including DV letters. The newer one is close to the top. It's just a sample letter, and I suggest modifying it some. Some people like to add in provisions of the FDCPA (like section 809 for validating debts). When sending, do it certified return receipt requested through the post office. It's around $6 these days.
Wow!!! Thank you so much, Mindcrime for your valuable advice and time. I really appreciate your thoughts and guidance!!! I was wondering if I could get your kind help with regard to two issues. 1. I do owe the hospital some money but not the amount they are claiming since a portion of the amount due was paid to the hospital by the insurance company. How can I state that in the debt validation letter so that I don’t get in trouble? In other words, in the letter to the collection agency, can I outright say that I do owe some money to the hospital - but not the amount claimed - and that I am ready to pay it once the correct amount has been verified? Or would such a statement somehow validate the debt they are asking for? Would it be better and safer for now to dispute the entire amount until the correct amount is clarified? 2. Would it be wise to get a copy of my credit report? The debt is fairly recent (from January and February 2013), and this is the first time a collection agency has contacted me. However, you mentioned that sometimes collection agencies report the debt to credit bureaus prior to contacting the consumer so I’m now worried about this. May be I should verify if the debt has been reported. I would greatly appreciate your kind assistance. Thank you once again for your kind help! Tom
From section 809 of the FDCPA: (4) a statement that if the consumer notifies the debt collector in writing within the thirty-day period that the debt, or any portion thereof, is disputed, the debt collector will obtain verification of the debt or a copy of a judgment against the consumer and a copy of such verification or judgment will be mailed to the consumer by the debt collector; Requesting validation of a debt isn't necessarily about 'not mine'. There's an allowance for a middle ground, and yours is the ideal situation. Basically, the hospital bill is $10k, insurance paid $5k, balance claimed due is $7k....how can that be?! (just an example, I'm not using your figures from your org post of course)....therefore, you are well within your rights to request validation of this debt because you believe it to be incorrect. You don't necessarily have to say "I know I owe you some money, I'm just not sure how much". Saying "I am requesting full validation of this alleged debt pursuant to...." is good enough. I think jam had mentioned something about an itemized bill, something where you can be sure that whatever it is they are claiming you owe, you actually owe. ($50 for an Advil that was never given type of scenario, I think he may have said). While I do not know anything about HIPPA laws, I would expect there has to be some way that you are to be given this. A piece of paper with California Hospital logo at the top and a $xxxx due at the bottom doesn't cut it. I'd suggest getting a copy. Go to annualcreditreport.com to get a free one from each credit bureau. You're allowed one report from each bureau per year. From there, another option is to subscribe to a credit monitoring service. There are a number of them out there. I use Equifax Complete Premier Plan. Although they've frustrated me a time or two, I happen to like the way it works and is set up and have stuck with them. The standard price is $20p/month; there are lower plans like Credit Watch Gold with 3-in-1 monitoring for $15, or $13 if you google the promo code. Whatever you decide, it's worth it, at least for the time being while you're straightening this out. And yes, there are lots of CA's that like to report debts before contacting the consumer. I dealt with one that had NEVER contacted me. I only discovered it when pulling a report for the first time in quite some time.
Thank you so much for your detailed, clear and thorough response, mindcrime!!! I greatly appreciate your kind help!!! Tom
Hi Tom, I am working on a campaign to regulate how hospitals in California charge patients for care. I'd like to ask you a few questions offline- by email? -Anna
