I had some procedures done and was told insurance was billed. Got a bill from the place that did the tests, saying to resubmit insurance information. I did that. Never heard anything. Then I got a collection letter for the full amount and wrote to OC and included insurance info again, but sent CRRR. Got letter back, saying account does not exist. Now I am getting another letter from a different CA for this account. When I write the validation letter, should I include asking about proof of insurance billing and refusal of company to pay and reasons why. Someone had to screw up in the insurance billing part and I am sure it is too long now for the insurance company to pay. Am I stuck with this bill? What should I do next?
1*Got letter back, saying account does not exist. Now I am getting another letter from a different CA for this account.~~ 1*Send The standard Val. Letter. 2*When I write the validation letter, should I include asking about proof of insurance billing and refusal of company to pay and reasons why.~~2* No 3*Am I stuck with this bill?~~ 3*How can you be stuck with a bill that don't exist? 4*What should I do next?~~4* Send The Reg. Val. Letter. whatever
I've had similar problems with being billed for what should have been billed to insurance company. These accounts showed up on reports as CA accounts. I really wanted to settle these without waiting months for this to eventually be deleted and I wrote the CA offering to pay XX amount for deletion. I explained that I was wrongfully billed but to save time, I would pay the bill in exchange for a letter for deletion. About two weeks later, I was sent a letter from the CA saying they have deleted the entire account due to billing errors. Another CA just refused to settle for deletion. But when they were served the validation, they sent a letter within a week saying this account would be deleted. If you filled out paperwork for an insurance company to be billed for any medical visits, you are not LIABLE if the hospital/doctor bills you, unless it was a copay or not a covered procedure. I had a hospital do this to me over 5 times, BILL ME instead of the insurance company. It is such a hassle to deal with. I would call up the original medical service provider and request copies of account information. If you listed your insurance company, and they did not bill them, that is their PROBLEM! CA's should not be able to place these accounts on your report.
By the way, I recently paid off another "should have been billed to insurance" for $500 for hubby from six years ago. He cut his finger at work and the stupid hospital ignored the workers compensation insurance info and billed hubby. I paid this with the CA in exchange for deletion, but have filed a claim against the insurance company for reimbursement.
Under the Fair Credit Billing Act, FCBA. you are entittled to receive ALL the services which were agreed upon at the time of the transaction. Go to; http://www.ftc.gov/bcp/conline/pubs/credit/fcb.htm There you'll find the following item early on; They cannot bill you for; charges for goods and services you didn't accept or WEREN'T DELIVERED AS AGREED. Now, here's how it applies; when you go to a medical provider (mp) part of the "transaction" is that the MP will bill your insurance co. for you, on your behalf. If they fail to do this they have broken the agreement made at the time of the transaction and are guilty of a billing error. That's why Cindarella'a CA deleted, proclaiming a billing error - it was. Medical providers have 15 months to properly bill your ins. co. If they fail their claim is time barred and will not be paid. The MP and CA knows this. It is their hope that YOU won't know it. Billing YOU is their only hope of getting paid. However, that is NOT your problem. This is all assuming you gave them proper ins. info. at the time of service. Hope this helps.
1*If you filled out paperwork for an insurance company to be billed for any medical visits, you are not LIABLE if the hospital/doctor bills you, unless it was a copay or not a covered procedure. 2*If you listed your insurance company, and they did not bill them, that is their PROBLEM! 3* CA's should not be able to place these accounts on your report. Cinderella ========================================= 1* Cinderella are you sure this is not a fairy tail. In every case I've seen you are liable for every thing the insurance don't pay. I question it because it just sounds to good to be true based on my own experiences. I'm not trying to discredit you-just trying to get to the facts. 2* never works that way for me - usually it becomes my problem real quick. 3* there is no excuse for them being in the CAs hands period! It should be against the law for a creditor to turn them over to a CA or even try to collect on them at all. ~~~~~~~~~~~Excuse me isn't that what we pay the insurers premiums for ?~~~~~~~~~~
Now, here's how it applies; when you go to a medical provider (mp) part of the "transaction" is that the MP will bill your insurance co. for you, on your behalf. If they fail to do this they have broken the agreement made at the time of the transaction and are guilty of a billing error. Butch, ===== ====== ====== Doesn't the agreement you sign also say that you are responsible for any amounts not paid by insurance?
#1....Thank you for the insight and information. #2....If I am correct and many times wrong.....the part about paying what is not covered by insurance means that if insurance will pay X amount towards something and you go to someone not in the covered network you are liable for the non-covered portion. The tests I had done were covered by insurance and should have been paid. The tests were also sent to a covered provider as well. #3....as for standard insurance not HMO or PPO, you can be held liable for expenses that exceed "usual and customary". Finding what usual and customary payments are allowed is something that is near to impossible to find out.
#2 If the OC fails to bill your In.s Co. that does not mean the whole amount is the amount not covered by the Ins. Co. You may be liable for Deuctables, Co-Pays and amounts that EXCEED what is called the Usual and Custmoary Charge. It should say in your contract what heppens if an MP fails to properly bill. You should call your Ins. Co. in the morning and find out if they received this claim and when. Ask them for a letter explaining the specifics, whether they got the bill or not. #3 Your Co. should be able to tell you very easily. #4 Ask your Doc if he will accept the usual and customary charge for the services he performs. Or that he will accept what your Co. pays as full re-imbursement. BTW what ins co do you have? Let us know whatcha find out.
Ibrown, my post was directed at MP's for failing to bill insurance companies and then sending these accounts over to CA's to collect from the individual. My post was not intended to be an exhaustive list of what insurance companies are LIABLE for, but rather who is LIABLE when the MP fails to bill the insurance company. I briefly mentioned two obvious reasons as to why an MP would not bill an insurance company (copays, not a covered procedure). Ibrown, several times I have had MP's try to make me liable for medical charges that should have been billed to the insurance company. It happens. For whatever reason, the billing paperwork is not submitted to the insurance company, account remains unpaid, goes to collections, and according to the CRA reports, I AM NOW LIABLE. You are never liable for medical charges if the MP was provided your insurance info and failed to bill insurance company (assuming it was a procedure covered by your insurance, it was not for a copay, deductible, and does not exceed usual and customary charges.) By reading Whatever posts because based on what she said, it appeared a **billing error** occured. That is it appears MP failed to bill insurance.
Ibrown, my post was Cinderella ---------------------------------- -Thanks for this info. What has happened in my case several times is the insurer blames the MP and the MP blames the insurer. I have even had hospitals and labs blame the Dr. because the insurance Co.refused to pay them. In any event it's my contention that the patient should never be held liable to pay an amount owed by an insurer. This thing of pay the MP and fight the insurer for reimbursement is pure malarkey.
There was a recent article in the NY Times on the very same subject on how insurance comapnies are not paying claims and the hospitals/doctors are using collection agencies to go after people for the bills. The article is "Is your Health Insurance Hurting Your Credit", May 12, 2002. My daughter was recently in the hopsital, my insurance covers 100% except for the $100 deductable. But in re-reading the "fine-fine" print, the hopsital says it will bill my insurance provider for all "covered" costs, but - and its a big one - if the insurance does not pay the bill within 45 days of billing, I am have to pay and look to the insurance for reimbursment. I also checked with our family dr, they have they same clause in its forms for insurance information. <I"m a newbie but learning>
Under the Prompt Payment Provisions the Ins. Co. is required to make pmt. in 45 days, (may be 60 days). The hospital is talkin about services that are not covered. Isn't it interesting that they do promise to bill the Ins. Co. on your behalf. If they fail this promise they have screwed up not you. They have breached the contract. That was our original problem here.
I'm up with our 12 month old daughter (still not sleeping through the night). Searched Google and got nothing. Went to the NYTIMES.COM site, clicked advanced search, and found a link. Link: http://query.nytimes.com/search/abstract?res=F30F17F835540C718DDDAC0894DA404482 It's a premium-content link (to which the NY Times will sell access for $2.50). Um, no thanks. Doc
"The hospital is talkin about services that are not covered." And of course they want their $100 deductable or any co-pays within 45 days. Some Ins. Co' will pay perhaps 80% instead of 100% so you'd owe the difference. It is these expenses of which they speak.
Damn Doc, I tried to go ahead and buy it. I was gonna put it on here for everyone, but I got an error message that said my cc info could be transmitted to an unsecure site. I aborted. Sorry Guy's
Some Ins. Co' will pay perhaps 80% instead of 100% so you'd owe the difference. It is these expenses of which they speak. Butch, CFP ====== ======== ========= == The problem I'm addressing is the hospital trying to collect the 80 to 100 % from you instead of the Insurer; Happens to us all the time.
Hold everything! Some misconceptions here, I believe: fact: Providers bill your insurance company as a courtesy, if benefits were assigned, meaning the insurance co is authorized to pay the provider directly. Making sure it is billed and paid promptly is your responsibility. fact: the FCBA applies only to credit cards. "They" don't make things clear for the patient/customer. After you visit a medical provider, you should watch for the EOB (explanation of benefits) if you don't see one after two weeks have gone by, follow up on it!! Call the insurance company and ask if they got the bill. If not, call the provider and ask if they have billed the insurance company. If you get conflicting answers to your question (the provider says they billed and the insurance co says they haven't received a bill), start hounding them daily. Send certified letters to both so whoever is screwing up will be on the line when you file your complaints. Most of the time it is the provider not billing correctly (these folks are not adequately trained) but sometimes it is a sleazy insurance company trying to avoid payment. I go through this all the time with my Mom's stuff, and recently with my own dental bills. It is aggravating and time consuming, and God help the people who are too sick to follow up!! I do this for people as a "hobby." Elderly people and very ill people need help, and have a hard time getting it. There is an ombudsman, but most of them don't even know it!!
