Judgement-Summons???

Since this is a medical collection, what is the amount owed for? In other words, was this doctors visit/service performed covered under an applicable health care insurance policy minus applicable co-pays or deductibles?

If for whatever reason you simply failed to pay non-covered/out of pocket deductibles or required co-payments, then you can stop reading because I am sorry to say that what follows will be of no use but I am sure someone else will chime in. On the other hand, if your visit was covered by health care insurance, did the health care provider or doctor (hereafter referred to as HCP) file a claim with the insurance company within a timely basis (within 90-days)?

You need to realize that although the HCP literature (and CA) may state that you are responsible for the amount due should the claim not be resolved within 90-days, that is pretty much BS in the case of a covered claim. The HCP has a written, legally binding agreement with each insurance provider in which the HCP agrees to file the claim within a timely basis (90 days). Now it is possible that for whatever reason, the claim was filed within a timely basis but was denied by your insurance company due to incorrect, inaccurate, or missing information in which case. regardless, once again the HCP still has/had an obligation to correct the defficiency on the claim and refile.

If this was a covered event and your insurance provider denied the claim, then it may simply be a matter of getting them involved to see how to best resolve the situation. On the other hand, if the HCP failed in their obligations as indicated above, short and simple they can not send the account to collections as they are required to write this off as bad debt (as in the HCP screwed up and needs to write off the account). Problem is, the HCP may find it more convienient to ignore there agreements with insurance providers and prey on a percieved lack of knowledge of the patient instead! Afterall, who are we to question a bill collector to try and discern why a medical claim that should have been paid months ago is now in collections!

I had a similar situation with the ER at a nationwide hospital chain after a pretty good bicycle crash/accident. Every applicable HCP entity except for the hospital ER filed timely claims with my insurance provider and were in turn, promptly paid for their services. The hospital on the other hand, never even filed a claim, and it was not until nealry 7-months later when I got a call/letter from a medical CA that I even became aware of any problems. Since our helath care insurer provides online access to our claims history, it was not hard to see that the Hospital had never filed a claim which I brought to the attention of the CA. In fact, the only claim ever filed, was by the CA after I advised them that it was covered by inurance. Of course the insurnace company denied the claim since it obviously was not filed in a timely basis and apparently I was expected to foot the bill depsite the hosipitals incompetence.

More than 2-years after-the-fact, it finally took demand letters from my attorney and the office of the Attorney General of Texas to get their attention. Of course once they got the letters, I think they started to see the light as the account was adjusted to indicate a balance of $0.00 (got it in writing on hospital leterhead) and the debt immediatley recalled from the CA.


Michael