Hi folks, Per PsychDoc's Phase 1 of the primer: I'm a newbie here, please be gentle. Still slowly reading and digesting the great wealth of information here, but would appreciate any pointers regarding my situation in the meantime. Brief summary: hospital sends bills to wrong insurance company, tries to fix it two years later, insurance company denies claim as it is too old, hospital sent balance to collections. Details: 03/2004 Went to an in-network hospital for ER visit. Hospital admitted me, ran a bunch of tests, and I went home. I received EOBs from insurance company for some of the services rendered, which is expected, and leads me to believe all is fine. I was not aware that there were outstanding items remaining. 06/2004 I received two other bills from the hospital. This was surprising, as I thought that insurance would take care of all billing for in-network providers. Per my insurance, ER visits are completely covered if admitted. I called insurance company up about this, and they teleconferenced in the hospital billing department. Hospital rep and insurance co rep conferred, and they found that the hospital had sent the bills to the wrong insurance. Hospital rep said that they would resubmit, and insurance rep said that I didn't have to do anything else. I thought that was the end of it and left it at that. I guess my mistake here was that I never made sure I got an EOB from my insurance co for the bills in question. Fast forward to two years later, 2006: 04/2006 to 07/2006 Hospital sends me new bills for the two accounts in question from 2004. I call my insurance co and they said they would investigate. My employer also has a claims assistance team (CAT), and I inform them of this situation. From this point on, the CAT does all the chasing, calling back and forth, and following up with the provider and insurance company, and they provide me with frequent updates. They have been an excellent help (in my opinion at least). After some runaround with the hospital, CAT facilitates the resubmission of the accounts from 2004 to insurance, but insurance co denies the claims as the hospital did not correctly submit it to them within 180 days per the contract between the hospital and insurance co. I receive EOBs from insurance confirming this, also stating the same ("This claim cannot be paid because the provider submitted it later than 180 days after the date of service. You are not responsible for these charges. Please refer to the section of your contract or benefit booklet that describes the time limit for filing claims.") CAT confirms with hospital that they will zero out the balance for both accounts, per the contractually-valid denial by insurance, since it was the hospital's mistake in the first place. CAT confirms with hospital that nothing will be sent to collections. Just to be safe, I requested documentation from the hospital of a zero-balance for both these accounts. 08/2006 Still have not received the zero-balance documentation from the hospital, but a few days ago I received a call from a CA requesting payment for one of the accounts. I told the CA it was a hospital screw-up and it should be a zero-balance, and I would do some follow-up on my end (another mistake on my part talking to CA?). He says I can go ahead, but usually the consumers end up losing in these disputes between providers and insurance companies and wrecking their credit. I also report this to the CAT, who called the hospital and is trying to escalate this matter there as well. I received a first-notice letter today from the CA confirming the same. No activity so far on the other balance. Pulled an Equifax CR today, and there is nothing derogatory on my credit report (yet?). However, now that I have a letter from a CA, just wanted to make sure I preserve my rights and do the necessary, even while the CAT continues to pursue this. Should I be sending a dispute via CMRRR? To the OC (hospital) or CA? (should I have done that a long time ago -- was I too trusting of the CAT?). I guess I'm also not sure what I'm disputing, as I did go to the hospital and services were rendered, just that there were a lot of screw-ups after that... Thanks for reading this far!
It looks like up to now you have done everything right, but the hospital has not followed thru on it's contractual obligation not to collect on the debt that was not billed to insurance timely, even though they agreed to do so. Although this may be an error (the collections department doen't know what the billing and insurance claim department has agreed to) you want to ensure this does not damage your credit, even accidentally. The account has, in fact, been sent to a CA, in violation of the terms of their insurance contract and contrary to their representation to your CAT. The CA has, in fact, sent you a collection letter, which since they are acting as the agent of the hospital, again shows the hospital is acting in violation of the terms of their insurance contract. This is not an unusual circumstance. Hospitals contract with insurance carriers to get a share of the health care business from patients who have insurance coverage to guarantee payment. You, thru your employer, contracted with the insurance carrier to ensure you would have access to health care that you might need, and to ensure it would be paid for. The hospital agreed on the terms of payment with your insurance company, both with respect to amounts for various services and treatments, and with respect to their responsibility for the timely filing of claims for payment. That is what "in-network" means. They clearly had your insurance information, as evidenced by the sucessful processing of other claims. The hospital screwed up, and although they might reach some agreement with your insurance company on payment for a non-timely filing, your insurance company is obligated to you to, if necessary, enforce their contract with the hospital to ensure you have no liability. As referenced in your EOB, those terms were part of their representation to you of what you were buying when you agreed to sign up for their insurance and pay their premiums. Your EOB confirms your insurance company's determination of your liability under the two contracts. It is in the interest of all parties, within the broader scope of the various contracts, that claims be submitted promptly to ensure they can be checked for accuracy while the services provided are still recent, and paid promptly, so that the hospital can count on being paid. Both your insurance company, and the hospital at some level, are apparently aware of the contractual terms under which you (and your insurance company) are not responsible for claims submitted late. "I guess I'm also not sure what I'm disputing, as I did go to the hospital and services were rendered, just that there were a lot of screw-ups after that..." Those contract obligations supercede the original billing terms, just as the price schedule that is part of the contract between the insurance company and the hospital supercedes the hospital's list prices that might have been on some bill. They both agreed to it. What you are disputing is that the hospital is billing in violation of the insurance contract.
The problem is that the hospital has failed to submit their claim timely, as required by their contract, and they have now sent the accounts to collection, contrary to the terms of their contract. Based on this, you can't simply count on their apparent stated good-faith, while their actions show they are continuing to screw it up. The next step is likely to be damaging entries on your credit report, for a debt you do not owe. That is likely to damage you financially, even assuming you use the usual dispute mechanisms to get it removed. You could wait for that to happen, and then sue for damages, but because FCRA generally only holds them liable once you bring errors to their attention and give them the opportunity to fix it, they will probably not pay you a dime for that damage. It is best to head this off before it happens.
In medical collections, the CA often acts as in effect, an extension of the hospital's own billing. Medical billing and claim errors are not uncommon, because of the complexity of the bills, and the fact that a third party (the insurance company) is being billed and has a right to review and ensure compliance with their contract. It is clear from their statements that this CA knows this, and the ethical thing for them to do, assuming they were assigned the account still owned by the hospital, would be to check with the hospital themselves to determine if the accounts were sent in error, holding off any additional collection activities until that was resolved. The hospital's screw up, unfixed by the CA, makes both look bad. Instead they made a statement that we must examine to protect your interests. "He says I can go ahead, but usually the consumers end up losing in these disputes between providers and insurance companies and wrecking their credit. " Isn't it nice of him to give you permission. Now keep in mind that the CA doesn't get a dime unless you pay the debt, whether it is legitimate or not. What is this supposed to mean, given that the hospital doesn't put bad marks on your CR, they leave it to the CA? a) A comment on the weather? (Or an admission of negligence?) "These problems just seem to keep happening, and the consumers get damaged." (By us, of course. So if it happens, it is not our fault, since I warned you. Yeah! Sure!) b) A veiled threat (FDCPA violation bordering on extortion once the CA "knows" the debt is not valid): "You better pay us this debt that you don't owe, or I will trash your credit." c) A passive agressive threat (FDCPA violation, overshadowing): "You probably don't owe this, but you better not dispute even though we sent you the letter the feds make us send that says you can dispute, since by the time you get it straightened out, I will already have trashed your credit, and you will wish you just paid it." It really doesn't matter which they intended, since neither (a), (b), or (c) are good for you, and the CA would NEVER have put that in writing, but bullying people verbally is probably second nature.
If you want to head off both threats, and actual damage, for which you will probably recover nothing, you want to send these accounts at the CA back to the hospital as fast as possible, with all parties working to get this matter closed. You have three paths: a) Pay the bills. The CA will be happy, the hospital will be happy, and your insurance company might just let it go, since they didn't have to pay, either, so they got what they wanted. The hospital and the insurance company are off the hook, the CA got it's commission, and you are out the bucks. Everyone will just think you are a sucker, but they will probably let you do it since they don't have to do any more work, and you might still get a black mark on your credit, since it was paid "in collection", and your payment proves you "owed" it, you deadbeat. Why did you bother us over this if you were going to pay it anyway? b) Let the matter drag on. The insurance company will probably get it resolved with the hospital in time, but in the mean time, the CA will probably put a collection account on your credit reports, and you get to go round and round with the CRAs, the CA, and the hospital, to get it removed. c) Send a dispute/validation request to the CA, to preserve your rights, and make the accounts such a hot potato the CA races to send it back to the hospital, which proceeds to follow thru with zeroing out the accounts like they said they would as fast as they can. I don't know about you, but I would pick (c).
When you have a contract with another party, and they fail to meet their obligations under it, before you sue, you first bring it to their attention so that they can remedy the breach. You do it in writing, so that if later it goes to court, you can show what the breach was, and when you brought it to their attention, which may affect the court's determination of damages. The hospital, despite their agreement to zero out the debt, has sent it to collection. The CA, after you notified them the debt was disputed, and not valid under the hospital's insurance contract, has threatened to trash your credit. (Even though done on the phone, that was a dispute of the debt, under FDCPA, and the CA by it's response, clearly knew it was a dispute.) You need to make this situation clear to all parties, and in writing so you can prove they are all on notice. 1) To preserve your rights under FDCPA, so that the CA may not assume the debt is valid, send the CA a letter, CRRR, disputing the debt in it's entirety, requesting the name and address of the original creditor, and requesting validation. Include a copy of the CA's letter with your letter, to indicate what account you are referring to. If it is clear from the CA's letter that they are collecting on the same account as one of your EOBs, send a copy of the EOB for the account, circling the part where it says you are not responsible. You want to establish that just sending a copy of a bill is not sufficient to show that the debt is valid. Keep copies of what you send, along with the Certified receipt, and the green card when it comes back. You might call them, get their FAX number, and fax it to get it to them immediately, but if you do, still send it by mail, CRRR. 2) Send a letter to your insurance company (possibly thru your CAT), notifying them that despite the hospital's agreement to zero out the accounts, as required by their contract with the insurance company, they have sent one of the accounts to a collection agency, which after you notified them that the debt was not your responsibility, threatened to trash your credit reports anyway if you disputed the debt and didn't pay them. Request that the insurance company enforce its contract terms with the hospital. (You are notifying them of their obligation to you.) Include a copy of the CA's letter as proof the account was sent to collection. Your CAT may want to fax this to the insurance company. Keep a copy, and note the date it was sent, or if you send via mail, send CRRR. 3) You might also send a letter to the hospital administration, again CRRR, notifying them that despite their agreement not to do so, they have sent to collection an account for which you are not responsible under the terms of your insurance contract. Include a copy of the letter sent to your insurance company. If your CAT wants to be tactful, you might hold off on this letter until you see if the other letters are getting prompt results. The shit may hit the fan, but that is better than "accidentally" trashing your credit. Hyperbole? Or an accurate translation of their statement? If they didn't intend it, they can say so now. If they do, in fact, trash your credit, it was no "accident", it was intentional, so they better not do it. Regardless, sending to collection was a breach of the contract by the hospital, so notification of your insurance company of that breach was both proper, and necessary to enforce their own contractual obligations to you. If it turns out the CA does trash your credit reports, on an invalid debt that they knew, or should have known was invalid, you are ready to hire an attorney. They will probably want to settle quickly. CAs play a game called "brinksmanship", since in general they would rather collect directly with minimal work than either validate or go to court. That is what their statement was, and they said it for a reason, in their own interest, to attempt to get you to pay a debt you didn't owe. In "brinksmanship", you put out your demand along with the consequences for not meeting it. You may, or may not, actually intend to follow thru, and as in bluffing in poker, the intent has no bearing on the play. That doesn't matter, since if it pays off enough of the time, it is still worth it. What matters is that the consequences be credible, regardless of whether they be legal or possible. Damage to credit is even more credible to most consumers who do not know what their rights are, and what their legal remedies are, i.e. to the "unsophisticated consumer" that is the standard against which FDCPA violations for deception and overshadowing are often measured. Note that "He says I can go ahead" does NOT weaken the play, whatever is said literally, since the demand and the threat were still made, and other statements cannot retract it, as evidenced by the uncertainty his statement created in whether you should just pay a debt you don't even owe, or hold the hospital to meet its obligations as you were entitled to. That was intentional. It is on this level that his statement was an FDCPA violation, both for deception (the consumer usually loses and has to pay invalid debts), and in overshadowing the letter he knew the CA was about to send you (the letter says you can dispute, but he has told you what will probably happen if you do). And that is why you have every right to call "Foul!". The reality is that consumers who do not believe they have any choice but to pay invalid debts often do pay them, and CAs are quite willing to convince consumers to pay debts they don't owe, even as they carefully avoid "knowing" the debts are invalid. OCs use third party CAs for this very deniability. You can play, too, but you don't have to play by their rules. In this case you block the threat (rendering it no longer credible as a bluff) by disclosure to your insurance company as the contract violation that it is. Such disclosure now creates a credible counterthreat to the hospital, and thru them the CA, due to the breach of contract and resulting legal consequences should they follow thru with their threat. This counterthreat is based on the insurance company's interest in enforcing their contract, which is obligated by your notice and request to them that they do so. The CA's threat now becomes, to the hospital, a risk. Not only that, but it is clear to both CA and hospital that you are willing and able to pursue paths they may not want to go down, as opposed to silently putting up with whatever crap they do. "Brinksmanship" from the consumer's side makes the account a hot potato, and your position is consistant with any legal action you might have to take if they are foolish enough not to close out these accounts promptly. Note: I am not an attorney. If you want legal advice, see one.
Another form of "brinksmanship" for money is called "protection": http://en.wikipedia.org/wiki/Army_Protection_Racket "[What if] some of your tanks was to get broken and troops started getting lost, er, fights started breaking out during general inspection, like." A third is "MAD" (although I doubt a CA would play this very far): http://russianforces.org/blog/2006/04/dr_strangelove_meets_reality.shtml "Dr. Strangelove: Of course, the whole point of a Doomsday Machine is lost, if you *keep* it a *secret*! " - "Dr. Strangelove", directed by Stanley Kubrick
Hi ontrack, Thanks very much for your lucid, detailed responses. I was quietly hoping you would reply as you seem to be one of the experts around here, at least for the few medical threads I've searched and read here I understand that you are not an attorney, but truly appreciate your reading my post and replying. FYI, I called the CAT again today and they have yet to hear back from the calls they made. Since I always hear their message about recording all calls, I asked if they also do that for calls with the insurance co, hospital etc., and they said they do it for all calls, both incoming and outgoing. So, hopefully there is some record there of the hospital saying they will zero out the balance, if it comes to that. At the same time, since it ultimately involves me, I will digest what you've written and proceed to write some letters... in the end, the CAT is just an assistance team. As for the CA, thanks for pointing out the "veiled threat/passive aggressive threat" aspect; I had not even considered that angle. In terms of their first notice letter, it does seem to meet the five basic FDCPA requirements (amount, name of current creditor, thirty day no-reply assumption of debt, ability to dispute/request validation, ability to request name and address of OC), so they don't seem that sloppy on paper. Regardless, I have also sent off a request to the state to see how their statutory bond is doing, per NanaC's suggestions. The CA called me at work -- wonder if I can invoke FDCPA § 1692 c(a)(3) about them not being able to contact me "at the consumer's place of employment if the debt collector knows or has reason to know that the consumer's employer prohibits the consumer from receiving such communication". Don't quite understand why my employer needs to prohibit it first, although I could tell them that personal calls should be minimized and be taken at home.
Just to add: one other thing I am considering is to pro-actively reference the other account balance which has not been sent to collections yet (or at least I haven't found out yet) in the communications to the insurance company/hospital/CA. Or is that not such a good idea?
The CA has called, and sent a letter, on one account at this time. That is the account you need to dispute/request validation under FDCPA, as promptly as you can. You must do this within 30 days of receiving their letter, but you would be wise to do it immediately, since on receipt of your letter, until they send validation, they may not assume the debt is valid and continue to collect. Since collection includes reporting it on your CR, verifying in a dispute thru a CRA, additional calls demanding payment, additional dunning letters, you want to remove their ability to do any collection as soon as possible. Keep your letter to the CA direct and focused on your request under FDCPA, since you want their obligations, or failure to meet them, as clear as possible. If you mentioned both accounts in your phone conversation with the CA, and if their reply in that discussion included that "usually the consumers end up losing in these disputes between providers and insurance companies and wrecking their credit", your letter to your insurance company or the hospital should include that their threat was to trash your credit to collect on both accounts. They made the implication, they should be stuck with the consequences. Regarding calls at work, FDCPA does not blanket forbid them, unless you specifically notify them that your company does not allow them. There is nothing illegal about their first call, even if it was to you at work. Once they receive your validation request, however, sent timely within 30 days of your receipt of their first letter, they must stop collection, which includes calling, whether at work or at home, until they send it. For now, I would leave the work call issue untouched. They may violate by collecting without validating, via telephone, and it could be useful to get your CAT on the line to verify that violation. How much money is at stake here? Keep in mind that although to each party the money may be important, there is also a larger issue of credibility and reputation for honoring contracts at stake, credibility between people who routinely work with and depend on eachother, that exceeds the value of the money. It is always someone's job to see that problems do not happen, or when they do they get fixed. It is their boss's job to do the same if the responsible party under them fails to. This applies to all but possibly the CA. To the CA, this is a one-shot deal. Note the difference in behavior that produces. But also note that if even they screw up badly enough, particularly in legal non-compliance, it becomes in the interest of the hospital to dump them and blame them for the whole problem. Your hospital signed a contract with the insurance company. Their credibility is at stake, and possibly future business should the insurance company not renew the contract as a result, or loss of face with people they routinely work with even if they do renew. That does not make their doctors happy. Your insurance company signed a contract with your employer. Their credibility is at stake, and possible future business should your employer disqualify them from offering insurance to your co-workers. Some insurance executive might lose a bonus, or even his job, if that happens. Your employer has an agreement with you. You and he are paying the premiums on this policy, and you both have a right to expect that the insurance company will deliver what they promised. It is bad for morale when employees get injured both physically and financially due to an insurance screw-up, and it can turn a benefit into an incentive for good employees to leave. All the above consequences can dwarf the actual amount of money involved, since problems in this case could be an indication there will be further problems in other cases. It is in each party's interest that they be perceived as reliably honoring their commitments and contracts, and that they have confidence that their partners will do the same. That is the strength of business relationships built on contracts and on-going business. The value of honoring obligations spelled out in the contract on each covered case exceeds the actual dollars involved, since what is at stake is the total business represented by the contract. That financial incentive to enforce the contract terms may far exceed the practical options available even in court, after considering the cost and delays of litigation. Do not let anyone off the hook. Keep them all engaged and responsible for meeting the goal of doing the right thing and honoring their agreements. That includes your CAT, as their involvement represents your employer's interest in the matter, and all the other parties know it.
Letters: I've faxed and sent a letter via CMRRR to the CA two days ago, loosely based on the debt validation sample letter. I did not include the EOBs, but I added some language notifying them in writing that the debt was not my responsibility per the contract between the hospital and insurance company. Working on the letter to the insurance company and hospital next. How much money: here's the interesting part, even though my insurance company says they didn't pay the hospital, from the statements the hospital sent me, it appears that their computer system deducted an "insurance contractual allowance amount" (for the wrong insurance company), and they're trying to collect the remainder from me. However, per my insurance company's plan, if it's in-network, they cannot claim the difference between the contracted price and their "retail price". Not sure if that is the case for the other company/plan the hospital incorrectly billed me under. Across both accounts, the "retail price" total amount is about $2,600; the hospital is trying to collect ~$700 from me (the CA amount is less than that since it's only on one account so far). Since my insurance company didn't pay the hospital, the EOBs I have do not indicate their contracted amount, which is why I didn't send the EOBs to the CA as the figures don't match, and the EOB does not indicate the provider account number. If the CA does come back and sends something to "validate", would that be another strategy? Something along the lines of "if you claim that insurance paid you $x out of $y and you're trying to collect ($y - $x) from me, since it's in-network, you can't do that"? In this instance, what would constitute "validation" anyway? I've heard from the CAT that they were trying to get a UB-92 and/or proof of timely filing from the hospital, in order to appeal the non-payment with the insurance company (if the billing screw-up was on the insurance side), but they never did give the info to the CAT. That's why they then told the CAT they would zero balance it. Maybe they were going to just zero the insurance portion and try collecting the balance from me. Contracts: Good points about the contracts/credibility/reputation. The additional wrinkle is that my employer no longer offers plans with this insurance company, so when I contacted them earlier in the year, I had to liaise with just one person from the "old accounts" department who handles my employer's account. Anyhow, they should still be bound by the old contracts, right? Is there a SOL for contracts? Also, from what I can tell, it appears that this hospital is no longer an in-network facility with the insurance company (doesn't show up on the insurance company's website now when searching for hospitals). On another note, should my insurance company be non-responsive, I would probably have to file a complaint against them. I thought I read somewhere that if it's an employer-designed plan, I can't file a complaint at the state level but have to do it via the DOL under the ERISA, but I can't locate where I read that...
Whatever the hospital billed and adjusted based on the wrong insurance is irrelevant. It just shows part of where they screwed up. The only contract that matters is the one with the insurance company you were actually covered by. They also somehow managed to send some of your accounts to the RIGHT insurance company, and if they had sent these ones there in time, they would have been paid. If your CAT has not already done so, they should send a follow-up letter, summarizing the conference call on xx/xx/xx and the hospital's agreement to zero out the charges in compliance with the insurance contract, then indicating that the CAT had requested documentation on xx/xx/xx confirming that the accounts had been zeroed out as agreed, but had as yet not received anything from the hospital. Request that this matter be closed out promptly. CC to the insurance company, and to you. You want it in writing what the state of the account was, what was agreed to and by whom, and when. In this case, accurate validation from the CA would show an accounting in compliance with your insurance contract. It might show an adjustment based on your insurance company's schedule, and since no amount is due, it should be zeroed out, with no amount due from the patient. Any other validation is erroneous and a breach of the insurance contract. If the CA sends you anything other than $0, you would forward that to your insurance company to determine whether the hospital has breached their contract and failed to follow thru with their agreement in the conference call. You could, "as a courtesy", send a copy of the letter you are sending to the insurance company to the hospital administration. And send another dispute back to the CA indicating that the "validation" is disputed, since it indicates patient billing not authorized under the insurance contract. (Everything CRRR, of course.) The exception to the above would be if your insurance company agreed to accept the hospital billing, even though late, and a patient co-pay was legitimately due.
Hi ontrack, Back with an update; apologies for the silence. I have been away on travel and the CAT has been working on this. Not much has changed really: I have not heard back from the CA (nor OC/hospital) since I sent the validation letter. Thus, they seem to have ceased collecting for now, and from what I've read, I don't think the FDCPA mentions anything requiring them to respond in a timely manner, or at all. Seems like only Texas has laws giving a time limit for the CA to respond? Anyhow, I want closure on this to prevent any future re-occurrences i.e. a letter stating zero-balance, so I wouldn't consider this issue closed yet. As a result of my letter and/or the follow-ups between the CAT and insurance company, the insurance company and CAT have been in contact with the CA and OC/hospital. I was told that the OC claimed the CA was going to send proof of timely filing, which was why they didn't zero-balance it, but the CA said they don't have it and that the OC was going to send it. I doubt if either party has this proof, because if they did, why didn't they just send it to get paid and get this over with? CAT brought this (mis?)information back to the OC, and the OC supposedly conceded and said that they will send me the zero-balance letter within two weeks. Naturally, I didn't get my hopes up, and sure enough, it has been more than two weeks with no letter. CAT says they will follow-up. My take is that I should send another follow-up letter to the insurance company given that the OC has proven to unreliable up to this point. I actually asked the CAT about this, and their thought is the hospital never did receive any payments, but is just applying some adjustment contracted amount for the wrong plan they billed to. However, this could be (and probably is) different from what my employer's plan's contracted amount is. I will check and see if the CAT has had any written communications with the OC. I believe so far this has all been worked through recorded phone conversations.
On a case like this, where one or more parties may be stalling, you want your CAT to follow-up each communication or contact IN WRITING, summarizing who they talked to and when, any agreements made, or any promises made to provide documents. S/he should forward a copy of that to YOU. Phone calls alone do not drive a negotiation forward where some parties have nothing to gain by driving it to conclusion. You want memorialization of all conversations, in writing, and that were sent to the other party shortly following, to pin down any progress. Best is to prepare a letter addressed to the other party summarizing a phone call immediately following, FAX it over (keep the fax receipt), mail a copy, file a copy, and give you a copy. If you (or your CAT) does not receive requested documents (in say, a week) send a follow up letter. ("As you recall from our phone conversation on xx/xx/xx, you were going to send me .... I still have not received these documents. Please send them promptly.") Keep it moving. Delay and silence does not do this. Take a lesson from the debt collectors: There is no reason for more than a week or two to pass without contact to continue pressure. Stacks of letters, one for each call, and another as follow-up, start to create the paper impression that the other party is either incompetent, or deliberately stringing you along.
"As a result of my letter and/or the follow-ups between the CAT and insurance company, the insurance company and CAT have been in contact with the CA and OC/hospital. I was told that the OC claimed the CA was going to send proof of timely filing, which was why they didn't zero-balance it, but the CA said they don't have it and that the OC was going to send it. I doubt if either party has this proof, because if they did, why didn't they just send it to get paid and get this over with?" Told by who? If this was verbal, was there a follow-up letter memorializing it? Certainly they should send it if they have it as part of validation, but this does not establish YOUR liability. It supports the case for the HOSPITAL collecting from the INSURANCE COMPANY, and it MIGHT support the case for you owing a co-pay regardless of how the hospital and insurance company settle their claim. I thought the problem was they billed the WRONG insurance? Will the correct insurance company accept the timely filing of a claim with the wrong insurance as a timely filing for purposes of binding their own payment responsibility? Or was there a timely REFILING done later with the correct insurance company?
"CAT brought this (mis?)information back to the OC, and the OC supposedly conceded and said that they will send me the zero-balance letter within two weeks. Naturally, I didn't get my hopes up, and sure enough, it has been more than two weeks with no letter. CAT says they will follow-up. My take is that I should send another follow-up letter to the insurance company given that the OC has proven to unreliable up to this point." Did the CAT send a follow-up letter to this call? If not, they should immediately. If you give up enough wins, you can still lose.
While this drags on, let's recheck the basics: 1) Did the CA send you your FDCPA required letter notifying you of your right to dispute and request validation? 2) Did you dispute and request validation in response to this letter within 30 days, or if you never received any such letter, did you dispute and request validation in response to information on your credit reports? 3) Have they sent you any validation at this time? 4) Are your credit reports currently showing this collection account? 5) Has the CA or OC called and requested payment since receiving your letter? 6) How much do they want? 7) If so, have you disputed thru the CRAs, following the receipt by the CA of your dispute/validation request? 8) How much time has elapsed since sending them a dispute/validation request letter? Note: I am NOT an attorney. I just believe that anyone that expects a consumer to meet his obligations should first meet their own.
Just posting a long overdue update for closure. Not sure if it was through the activity of the CA/CAT and/or my letters directly to the insurance company, but somehow the OC/CA came up with some proof that was satisfactory to the insurance, and they paid the claim. This time I made sure I got an EOB confirming this. ontrack, if you're still reading this, thanks again for all your efforts. Yes i) Yes; ii) N/A Never did receive any further correspondence from the CA. No, and never did (as far as I'm aware) when I checked my CR. No. The original amounts "retail" amounts listed above (~$2,600). N/A since it never appeared on my CR. Moot point at this juncture
Our local hospital is so bad the contract they have with the collection agency is that it will never be reported on a credit report. They must have lost a few suits or POed the wrong person.
It is possible to get a patient advocate or mediator to work on your behalf. You can find them on line by doing a search for healthcare mediation or bill mediation. They help by getting in-between you and the provider, insurance company or the collection company.
