Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation LBrown, I wish you would try to find a requirement -- you're so quick to keep stirring, quoting, re-numbering and beating a dead horse but you won't do a yot of research. How can you advise someone that it is a violation of something if there is nothing to base it on? Of course there WAS a bill, the insurance company paid in full based upon it -- there is nothing requiring that the doctor bill the insurance company however, they did so, and as a courtesy. You and Jam keep saying the doctor's office then had to bill AMD, what requires them to do so? Sassy
Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation amdmp To answer your question about the check, the mostly scenario is as follows. The DR that treated your daughter was not part of your HMO's provider network. When the Dr billed the HMO, the fee was drastically higher than what your HMO pays to it's in network providers. Your HMO most likely contracted the DR in an attempt to get him/her to accept the insurance check as payment in full on the HMO's part. The DR refused and demanded payment based on the percentage amount(s) stated in your policy (60-70% for non providers) or made an offer in which the HMO just plain refused. Most States, if not all, require Insurance Companies to make payout(s) in the amount as stated by the terms of the contract on any valid claim or face penalties and sanction for not doing so. After the DR refused the HMO payment, The HMO sent you the check and recorded it in their records as a payout on the DR's Claim, thus satisfying any regulatory payout requirements. Your cashing of the check constituted settlement of the DR claim and released the HMO from any further payment liability. The HMO did not assume anything when it sent you the check. They simply wanted you to cash it, so they could record the payout, that it had been accepted and closed the file on the DR's claim. You unknowing settled the Dr's claim and have taken full responsibility for any unpaid balance due. If you had not cashed the check, they Insurance company/HMO would have had to settle with the DR themselves and most likely the DR would have received payment in the amount that would have satisfied his/her claim/bill. Sorry. I don't think it's right, but there is nothing illegal about what the HMO did. In fact most State's have made this type of claim settlement tactic perfectly legal. Some States go a little further by requiring the HMO to disclose the fact that the cashing of the insurance check settles the claim and releases the HMO from any further liability.
Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Thanks Prosub but we basically knew this. The issue which is pertinent to AMD's credit report is the "mistake" made by the MP for not, "in good faith", "making a sincere attempt" to collect any deficient amount from AMD, PRIOR to heavy handed collection efforts. SUDDENLY - 2.5 years later, she's contacted by a CA, and her report either is now or soon will be trashed for seven years? Preposterous.
Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Whether the DR refused the settlement/payment offer is pertinent. If Amdmp really wants to use the time delay in billing as a claim for none payment. she will have to check her State Insurance Laws/Regulations or UDAP statue to make sure that the DR was not barred from billing her while the bill was under dispute with the Insurance company. Some states prohibit such practices and consider it fraud for person/business (in this case the DR) to bill, for payment in full, an insurance company and the policy holder at the same time. Or to bill the policyholder prior to receiving payment from an Insurance Company or in the case of a disputed claim, a dispute resolution to the claim. Commonly referred to as Double Dipping. She may also want to check and see whether or not the DR sued the HMO and received payment.
Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Finally!!! Prosub, Where can we find those regulations? Sassy
Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation However, typically DR's don't have to send a 'bill' per se. Chances are you've received a DR's office statement which says something to the effect "This is not a BILL, this is a statement for your records of our bill to your insurance company." If the consumer had received even a statement which was not a bill, then they could have taken the money to the DR, and said, this is from my insurance co.
Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation New York UDAP New York Executive Law, Section 63(12). New York General Business Law, Sections 349 and 350. Now, to look through them to see if there is anything relevant.
Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Under UDAP... Even if something is *NOT* illegal, it can still be a violation of UDAP, if it is UNFAIR. Is it fair, that a consumer should have to call the Psychic Friends Network, or go on Montel to ask Sylvia Browne who they are supposed to give this money to? Are consumers supposed to be able to pick up the vibrations from the check to determine where they are supposed to take the money to? Does it offend the public (i.e. a potential jury of AMD's peers) that the DR, would send the account to a collection agency without the courtesy of sending even one statement to them? Is it unethical to do so? In other words, it may technically be legal, unless we can find a specific statute which makes it illegal, but is it ethical? As Butch pointed out, the presumption of DR's ethics may be why in trial what the court considers to be proof of the debt, would be of a lessor standard for a medical debt, but if the DR shows that they've acted in a way that the public would consider to be less than ethical, would the court still decide that that lessor standard still apply, in AMD's specific case? Did the DR's actions in this situation result in substantial injury to the consumer? Well, if CA1 and/or CAA2 placed a negative tradeline on AMD's credit report for $1,100.00, would a jury find that said tradeline wouldn't amount to substantial injury to the consumer?
Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Sassy; Sorry for the delayed response. You'll have to check the statues and/or regulations for your particular State. Each State is different. The best place to start is usually with your State's Office of Insurance or the State's Insurance Commissioner's Office. UDAP statues also very from state to state. what might be considered unfair or deceptive in one state may not be in another state. Should she have been notified that there was an problem between the DR and the HMO, absolutely! Should the DR have first tried to bill her before turning it over to a CA, again absolutely! But this is not case. But please keep in mind that most businesses only do what the laws and regulations mandate they have to do, some businesses don't even do that, CAs and Attorney/DCs for example. If there is no requirement in the stat/reg that they (the DR or HMO) have to notify her of the dispute/problem, they won't. Ethic violation(s) suits/claims can be extremely tricky to win in court. Most Ethic Doctrines are written and enforced by members of that profession (i.e. Bar Association, State Medical Review Boards etc, and are limited to the duties (in this case, the DR's medical care and treatment of his/her patient) directly performed by the professional and have little or no bearing on the business aspect of their practice(s). In many Ethic violation suit/claim, one of the Major elements that a plaintiff must prove, ex-specially in cases involving DRs and Lawyers, is that the professional's (in this case the DR's conduct) was so outrageous that it would shock the public at large and/or said conduct/behavior is considered unacceptable for a person of their position or profession. This also includes negligent treatment or care. Heck, DRs are not even required to take the Hippocratic Oath anymore. Also keep in mind, that the courts will only permit arguments as they pertain to the law and/or the facts of a case. If neither side can agree on the facts or laws, then the Court will decide what facts, what laws and what evidence will be presented and seen by a jury, and this is all done before the trial begins. A judge could easily decide that the turning over of the obligation to a CA was neither improper, outrageous or unethical.
Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Not when AMD received and cashed an $1,100 check. It reinforces the argument that the doctor is the one that was injured. I asked and don't believe it was answered, whether or not it was reporting. Nodding, but none of them address billing practices as they relate to a consumer -- all there is governs services provided on behalf of the government and the contractual agreements between the insurance companies and the service providers. If there was a regulation requiring a particular billing practice anywhere it would be in the contract between the HMO and doctor. There's no resolution available for a consumer through those statutes -- perhaps under the UDTP there could be a complaint made with the enforcing authority, usually the AG. Agreed AMD should have been notified, but there is nothing requiring it. Without a requirement, it perhaps wasn't nice but that's all it is. It's not nice when my newspaper isn't flung to my front porch either. Agreed, that's the point I've been trying to make. I think it's a stretch to call it an ethical violation. That is nearly the question posed at the start of this thread and based on the postings what I believe most likely would occur. I'm flying with ya! Sassy
Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation I keep thinking about this thread and several things are bothering me, especially since the advice of the attorney was to make payment arrangements with the CA (oyyyyyyyy): What state is AMD in? Is the CA licensed/bonded as required? What is the SOL for enforcement? Some states require proof of debt be attached to any complaints for a judgment to occur. Did the letter have the validation notice or mini-miranda on it? Is this TL reporting or not reporting, if not, what was the validation letter sent in response to? Is there a payment for deletion arrangement? I know we got off the validation issue and what was provided came from the OC by the posts, but this is the 2nd CA too, was this debt assigned or purchased? A total amount due by itself, and then making arrangements to pay on a total, with a 2nd CA even -- that will just result in a paid collection someday being reported. What is very funky is that the statement is for the exact amount of the insurance check -- that almost never happens with medical bills. I know this post seems contradictory, but it is not, it bothers me muchly (yes muchly) that AMD paid good money to get the worst possible advice for a consumer from an attorney. The bill being in the daughter's name is easily addressed as an error; the statement coming from the OC isn't enough to tell what it is for; the cashing of the check doesn't look good for AMD but it still doesn't mean they are responsible for the amount claimed due. Could they get validation or couldn't they, the liklihood depends on the questions above that weren't asked. If someone should be getting paid, it should be the OC service provider and not the CA. This just sucks all the way around. Sassy
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Nice post Sassy but I thought these were the issues all along rather than the posters morals, ethics or obligations.
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation I'm not going back there, LBrown, like I said previously, you're just stirring. You won't let go and are so quick to dog on WhyChat and I -- I'm just as disappointed and shocked at your insistence on keeping this an issue and in front of the substance of this thread, no matter how many times it has been explained and no matter the number of apologies already made. The issue never was the poster's morals, ethics or obligations OTHER THAN how what transpired would impact a potential judgment as they asked. And no, they weren't issues all along because they were never brought up or addressed and should have been. Sassy
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation That's because we can't get YOU past this one issue. We haven't lost sight of Pro's problem. The trouble is getting you to see some simple "common sense" issues, so we can ALL move on. NOW HEAR THIS - YOU DO NOT NEED A "WINNABLE" CASE TO HAVE A "LEGITMATE" ARGUMENT! contra bonos mores Late Latin : harmful to the moral welfare of society Example: an act contra bonos mores Anything which defies fairness is harmful to the moral welfare of society, [against public policy]. The natural consequence of the MP's negligence is a derog. It is not even possible to suggest that a negative TL on ones credit report (presumably for 7 years) is anything OTHER than harmful. If one has read my "Rule of "72" and Your Sore", one can see the HALF MILLION DOLLARS LOST just on ONE mortgage, because of the loss of a few FICO points. Which has nothing whatsoever to do with "being nice"! Pro, When/IF we can get beyond this ridiculous argument about the difference between legality and fairness, (equity) we do need to look at Sassy's legitimate validation questions. email me if you need to. .
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Ummmmm, we are beyond the issue, as confirmed by pro, there is NO requirement. You can't yell inequity without looking at the actions of AMD -- which is and has been quite the point. Sassy
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Butch There's no problem here, I, PERSONALLY, believe that AMD was treated unfair, but whether I believe it was unfair or not is IRRELEVANT. The Court will decide that. If AMD can't present an argument with merit(s) support her claim(s), the court is not going to allow the argument and a jury will never know about. The court will also look at Reasonableness. Is it reasonable for the DR (as a BUSINESS PERSON and not as a DR. After all, whether he treated AMD's daughter correctly or not, is not the issue.) to have turned the account over to a CA to collect payment for a debt the DR believed he/she was owed. If the court decides that there is nothing UNREASONABLE about a BUSINESS PERSON using a CA to collect debt(s) for services rendered, An ethic suit/complaint for him doing so would go right out the window. Some of the possible court arguments/defenses that where being suggested are not as easy to prove/establish in a court as you might think. They sound easy, look easy, but in reality they can turn into a nightmare and destroy a case in a heartbeat if you haven't done your homework, especially when in Insurance Companies are involved. AMD ask for help and got it. But does she also desire to get as much information as she can so she can make the best decision. I'm not trying to suggest that she just throw her hands up and surrender. All I'm suggesting is that she at least needs to know that there maybe laws in her state that explain why the DR and/or HMO acted the way they have. She'll need to do some homework on this. It would be adding insult to injury if she walked into a courtroom thinking she's got one heck a case/defense; only to have the judge dismiss every argument/claim because the action(s) of the DR and HMO are covered by law and there was nothing improper, outrageous, unfair or unethical about it. As for Validation, not only should she request it, she should DEMAND it. she could also demand a copy of the written Contract/Authorization bearing her signature. if there is no contract/Authorization she could request an explanation from the DR as to what or who's authority authorized him/her to treat her daughter. She can request an itemized list of services rendered, requiring an explanation for each the service(s). If there is no written contract, she'll need to find out what type of contract the courts have determined these types of situation to fall under, , oral or implied contracts, etc, etc. Once she has that information, she could check it against her state's collection SOL. She may discover that the SOL has expired on a debt with this type of contract and that the CA is attempting to collect a Time Barred Debt. Or she may discover that her state's laws/SOL limits collection of Medical Debt(s) to a certain time period, regardless of a contract.
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Thanks for re-stating again, pro, I'm still flying with ya!!! Maybe Butch will read your post this time instead of thinking you were posting with a problem, instead of AMD, and instead of confirming what he doesn't want to read. He was only trying to take a pot-shot at me, his post doesn't make any sense and he's obviously not following the thread. Sorry you got misread and stuck in the middle, your information and posts are awesome and the common sense much needed -- most certainly with the directional pointers for finding and confirming the information. Sassy
Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Medical Debt Validation Sassy No problem, there's quiet a few issues involved with AMD's situation and I believe she entitled to all the information she can get. The CA or a Attorney/DC is only going to tell her what they want her to know and of course it will all be in their favor
