Hi, I need some advice regarding the following situation. About 3 years ago my fiancee moved from Colorado to Florida. She had lived there with her parents, and her medical insurance was under her father's contract. Two years ago she visited a doctor and insurance was supposed to cover her visit. All fine and good until this point. Well, last year, she checked her credit report and found out that there was a $100 charge that was sent to collections. After a little investigation, it turns out that the insurance company did not cover the visit. The medical office sent the bill to her previous address in CO, and her parents never bothered to let her know about it. There was also no letter from the CA. As soon as she found out about the bill, she paid it off directly to the medical office, so she's covered in that regard. However, at this point, there's still the entry on her credit report, and it shows off the amount as being paid. Is there any way to have this entry removed? If so, how? [Sorry if repost, I searched and didn't find a similar situation]
Did the doctor's office file a claim with her parents' insurance? Did she provide insurance information, and were they obligated to file a claim (were they "in-plan"?)?
The medical office filed a claim but the insurance company denied it - because apparently the doctor's office was outside their area. She did not know this, which is why the bill went unnoticed (and thus unpaid) for so long.
After reading some more messages here, it seems like the next thing to do would be to contact the CA directly and have them remove the entry from the CR. Is this correct? If so, under what reason? Also, would we need to dispute the entry through the CRA? Or just wait for the CA?
Did the insurance company ultimately pay some of it, or did they pay none? Did the doctor's office send a bill, and did they have the address to send a bill to? Out of area is not generally the reason to not pay a claim. A doctor is generally either in-network and under contract to the insurance company, in which case the contract would set what amount they were due, with the co-pay set by the insurance terms, or out-of-network, in which case the terms of the coverage would determine what, if anything, the insurance company would pay on the bill and any balance would be due from the patient. Even out-of-network providers often accept payment at in-network rates.
>>Did the insurance company ultimately pay some of it, or did they pay none? As far as I know they didn't pay anything. They said the doctor here was outside their coverage area. >>Did the doctor's office send a bill, and did they have the address to send a bill to? They sent a bill, but to the parents' address, in a different state. The parents never actually informed her of this letter (for whatever reason). Why the doctor's office sent the bill to the wrong address is unknown. >>Out of area is not generally the reason to not pay a claim. A doctor is generally either in-network and under contract to the insurance company, in which case the contract would set what amount they were due, with the co-pay set by the insurance terms, or out-of-network, in which case the terms of the coverage would determine what, if anything, the insurance company would pay on the bill and any balance would be due from the patient. Even out-of-network providers often accept payment at in-network rates. Perhaps, but it still happened this way. The bill was paid directly to the doctor, she was never contacted by the CA and the current report shows the bill as paid.
"Out of area" still sounds suspect. Have you obtained a copy of the EOB that indicated rejection of the claim? Does the insurance plan allow for some coverage paid to providers who are out of network?
We'll try to obtain a copy of that bill. The issue is not necessarily the bill itself ($100 worth). My problem comes from the entry on her credit report - it says "paid" but I still would like to have it removed.
Yes, the issue is not the bill, but the damage caused by it. You might ask that the TL be removed in a goodwill letter, but the provider will likely follow the CA's lead and say they can't, which is BS. What you want to give them is a reason why they should ethically, and arguably legally, remove it. If the claim was submitted erroneously, resulting in the claim not being paid by insurance, when it would have been paid had they not made an error, if insurance failed to pay a bill they were legally responsible for paying, and you paid it promptly on finally getting the bill, if you had provided them your correct current address, yet they sent it to the wrong address, and the delay in payment was caused by their own mistakes, those are arguments aimed at a human working for the medical provider deciding to overrule the CA because it is the right thing to do. We all have an innate sense of fairness and right and wrong, separate from written law. The medical provider probably has a stronger sense of it than the CA.
