Hi, I'm brand new to the board and VERY scared. I received medical services in August of '04 and my insurance paid the bulk of the charges, and I was to pay $10 per visit as a co pay. I received 30 treatments and paid on a weekly basis. I finished the therapy and never received a bill or phone call from the company. Three months ago I received about 25 letters from a collection agency saying that I owed money (different amounts) for the various visits. I called and they said they had recedived MANY phone calls regarding this. The collection agency really had no information on who the creditor was. They said they were looking into it and I should just wait and see if I received any more letters, or maybe they could work it out within the agency. I received two letters today saying that I owed a total of $3000 for these services! I called the agency and they said yes, the insurance company paid their portion but the remainder was my responsibility. I told them that I wasn't even sure what services they were talking about, but if it was what I thought it was, I paid on a weekly basis an amouint that was worked out before I received the treatments (I would NEVER had agreed to the treatments if it was going to cost me all this money!!). HELP! Peacheekeen
Did you receive an EOB from your insurance company for each of the treatments? That should show what claim was submitted, what amount they allowed based on any contract or agreed rates, what amount they paid, and what your responsibility was. Was the medical provider "in network", under contract with your insurance? If so, that would allow your insurance company to enforce the terms of the contract, both with respect to how much the provider can charge, and how claims that are submitted late are handled. Contact your insurance company and find out what claims were submitted on this. If your EOBs are not complete, they should be able to provide you with copies. How does the CA distinguish between each account? Do they reference an internal account number, an invoice number from the OC, a date of service, or what? With regard to the CA letters, dispute each one in writing, requesting validation, including a copy of the original bill. Set up a file and start keeping good records.
Realize that there could be several causes for this sort of problem: The medical provider might have screwed up their records, and be billing you for amounts already collected from insurance. They may have been sold, or gone bankrupt, and whatever someone thought was "accounts receivable" was sold to a CA, whether it had already been paid or not. They might have failed to submit claims, or might have made errors in submitting or coding claims, resulting in no payment or underpayment by the insurance company. On correction, the payments might then go thru. Or they might have failed to take into account price adjustments agreed upon with the insurance company. They may have delayed submitting claims beyond the period the insurance company required them to be submitted. The insurance company might waive that limit and pay anyway, or if the provider is in network and too much time has passed, under their contract they might be stuck, with no amount due from the patient.
