Medical bill from CA

It may depend on what state you're in. I'm in Tennessee, and there is a TN Rule for Medicaid that states that the service provider may not seek payment from TennCare (Our state's Medicaid) enrollees.

I called TennCare and requested a Certificate of Eligibility, and forwarded them to the CA.

Call your Medicaid provider and ask if there is a law or rule to prevent them from turning them over to a CA or "seeking payment from a Medicaid enrollee".

If so, ask them to give you the information so that you can look it up and quote it. Request a Certificate of Eligibilty from them for that time period also.

Send a letter to the CA, quoting the rule and enclosing a copy of Certificate of Eligibility (COE). I also sent a copy of my COE to the cra's with my dispute and the accounts that I was covered for dropped off. (Still got 6 out of 10 left...)
Shorty

 

Forgot to mention...
In my disputes with the CRA's I also quoted the law, by stating something to the effect that, "the Hospital was 'seeking payment from a TennCare enrollee' in direct violation of TN Medicaid Rule 1200-12-.08" and Enclosed were my Certificate Eligibility covering the service dates listed. Within a few days of receiving my letter, two of the accounts were gone.

The only reason all of them weren't deleted was because TennCare had terminated my coverage without notice, so I wasn't covered for some of the accounts. I filed an appeal with TennCare on the termination over 6 months ago and I am still waiting on the outcome. Regardless of the outcome, I have one of the CA's on a violation for failing to mark the 4 accts as 'in dispute'. The other keeps adding interest. Luckily, I qualified for legal aid when I filed my appeal and I mentioned these violations to my attorney the other day and she said we would deal with the CA's right after my appeal was finished.

Good Luck!!!
Shorty

 

I had a similar situation with a hospital bill that was sent to a CA.

I had medical which is basically the same thing as medicare.

the Oc( hospital claims that medical left a small balance and didnt pay the entire bill so they sent it to a CA.

bottom line when I called medical they claim the bill was paid and the hospital was trying to double dip charge both of us.

if you can get the medicaid office to send you proof or a letter that states the ca or OC should contact them for payment it will help you.

well in the three ring circus of the OC the CA and medical the final issue was my acct was deleted as they could not prove they were not paid.

guess I got lucky another thing is always ck out the CA and make sure if your state requires a license or bond if they do and the CA is not you can use that as leverage against them use their violation to get your deletion letter.

 

they told me the same thing they are trying to double dip. they figure that they can tell you that medicaid didn't pay so they can get you to pay again.

the fact is medicaid probably did pay and they may have a record of it as the hospital must have submitted a claim.

I would ask both the medicaid and the hospital for proof that a claim was submitted and if it was paid. and if they can tell you dates or give you further documentation.

I would also file a complaint with the BBB as well against the CA they know if the debt is disputed and hasn't been validated they can not pursue you until actual proof has been mailed.
also request that the CA flag your credit report disputed if they don't its a violation under the FCRA.

 

I'm going through that too (Dr. filing claim with wrong insurance, then waiting too long to file with right insurance.) I contacted my medicaid office and was told that the claim may be denied because they had waited to long, but that an appeal could be filed on it, and if the charges were incurred during a time of coverage it would be taken care of.

So, an appeal with medicaid is always an option, and while they are investigating it, it may come out that the bill has already been paid and the hospital is trying to double dip.

Also, if there is a rule that they can't seek payment from an enrollee, that would probably come out too.

Also, I would try to get the CA on a few violations too just as a guarantee that these would come off of my report.

As mentioned above, be sure to check your state laws for licensing and bonding of the CA.

Shorty

 

How far are you from the state capital?

Sometimes the main office will know a lot more, or have someone who is better versed in the 'rules' that they may be able to help you if you can drop by, or call their main office.

More than likely, the local offices are the front line troops, the main offices have more of the generals; and you need the generals.

The fact that it is above their time-frame is exactly why they need to help you, you just need to get someone who has a little more clout to help.

They should be able to find out whether or not they were paid, and if they weren't paid why they weren't paid. Did the provider dilly dally and let the bill languish away in a dark corner of his office filing cabinent for a year, before he decided to file it.

As with most insurances, there probably is a de facto rule that if the claim is not paid because it is not timely filed, the consumer is not liable, because it was the providers error.

Medicaid will probably even be a stronger rule than most insurances because of the financial considerations of its consumers.