In April, after stopping seeing the Drs for anything for more than 6 years, I decided to finally see the Dr, because for more than probably 4 months, my hands had been totally numb most of the time. Well, today, I get an invoice because *SOMEONE* either sent the lab the wrong insurance information, or they just said the Secondary Insurer is an HMO, lets make them Primary. What *REALLY* ticked me off is in fine bolded print, they have a veiled threat that they reserve the right to send this account to 'any of its affiliates.' ON THE FIRST NOTICE... How does this letter sound? I know it's probably more of a sledgehammer than I would have used, but threatening to send the account to their 'affiliates' on the first notice sent me over the edge. -=-=-=- This is formal notice that your invoice dated 09/28/2004 is disputed in its entirety. Please be advised that your company either was, or should have been provided the complete insurance information by the provider. This invoice is not my responsibility. Primary Insurance: XXXX Secondary Insurance: YYYY If your company correctly billed the correct insurance companies this invoice would not have been denied, by the secondary insurance company, because as your invoice pointed out, they are not my primary insurance company. If either insurance company refuses to pay for your services because of your company's improper billing, you are hereby notified that I am not, nor will I be responsible for the consequences of your company's negligent billing. Since your initial invoice dated 09/28/2004 contains a threat that your company reserves the right to assign this receivable to any of its affiliates, you are hereby advised that your company, and any employees of your company personally involved with the handling of this invoice will be held liable for any and all actions of any of your company's affiliates, including, but not limited to any derogatory reporting of this alleged account, which is not my responsibility, and resulted from your company's negligent billing of the secondary insurance company as the primary insurance company. Notice to agent is notice to principal. Notice to principal is notice to agent. Applies to all successors and assigns. CC: XXXX CC: YYYY CC: Provider, Billing Department
Well Jam - I feel for you! I really do. You have hit upon one of my largest pet peeves - medical billing. I spend a HUGE amount of time fixing their screw-ups and I'm to the point that like you, first bang and I have absolutely no sympathy. I go for the jugular! It's mind boggling how EVERY billing can get SO messed up! If it makes you feel any better, I had to have blood work, the lab sent it to a local hospital rather than their own laboratory and the insurance denied it. Well no duh! Now the lab that drew has no record of me and the hospital doesn't believe that I was never in their lab to get a blood draw. So no advice --- well I'll comment to say you were more toned down than I would have been - but I wanted to commiserate with you. Shanyl
I feel you on this run. I run 60-90 credit bureaus per month and I would say at least 75% off collection items - total surprises to clients - are medical collections for under $500, in which the insurance companies or the billing office dropped the ball.
What really burned me is right off the bat on the first letter, in microfine bolded print, the threat that they can assign the account. My blood pressure went through the roof almost as high (or higher) as its been for the last few months.
I feel for you too. I've got a situation with medical billing and insurance carrier here too. I'm not even going to write it all out, other than saying that obviously some people can't ****ing read and can't ****ing type properly. Hang in there. TexanCSI
Sounds good to me. The only real medical collection problem I've had was when I was involved in a car accident. Since I could have my company take care of the medical bills under my policy without it being a chargeable accident and not have to mess with the other person's company, I chose that route. Probably the best thing I did. It was obviously the other person's fault, but I had enough trouble getting them to fix the car and pay me a settlement. If they had been involved in this incident I might have ended up paying. Anyway, I was sent to physical therapy (for the second time). I gave them all of the information for my auto insurance. In fact, I believe I gave them my health insurance as well. Well, several years later (probably outside of the SOL, but back then I didn't even know or think to check that) I get a letter from a collection agency for $400 for this physical therapy. I called the auto insurance, thinking they had paid and it wasn't credited correctly. Well, they told me that they had asked for some backup information such as the notes. This is normal, I understand, for PT situations. They asked not only once, but FOUR times. Instead of sending the requested information and getting paid, they waited a while, sent it to collections and tried to collect from ME. Once I found out they could have been paid long ago but refused to file the proper papers, I decided I would NEVER pay this bill. I notified both the physical therapist and the collection agency that there was proper insurance, all they had to do was comply with the insurance company's request. After another six months or so of them billing me and me calling the insurance company, the insurance company caved and paid them to keep them off my back. If I had known then what I know now, I would have sued them for violations, continuing to try to collect while in dispute, etc. Wouldn't you love to see them in court? "But your honor, she refused to pay the bill." And my response, "Yes, your honor, because the insurance would willingly have paid, as they've been told numerous times, if they had only sent the required paperwork."
On medical billing, I'm to the point of following up and regularly prodding them if I haven't received a bill within 1 month of service. One of my last bills took 3 months to get them to submit in error, 2 months to correct, they got paid by insurance 2 weeks later, and my co-pay bill (and the first invoice I ever saw in this whole process) came 6 months after the original service. By that time 4 billing people in 2 departments, and some "ombudsman", knew me by name. Both medical billing systems and insurance payment systems are a black box to most consumers. You add 3rd parties on one end for services, and on the other for payment, and the consumer can't possibly know what, if anything, is owed to who, unless everyone competently does their job. When anything gets messed up, the consumer gets billed, at full rate, and often reported for late payment on a bill they never received from a company they may never have known provided service. After a hospitalization, bills still straggle in 6 months after you get out.
I agree, this is something that definitely needs to be fixed. I thought my bill had been paid long ago, as I hadn't received anything for several years, and I knew that my auto insurance was to pay in full. And my company is very competent and pretty prompt in paying. The orthopedist, the hospital and everyone else had long since been paid.
Regardless of who screws up, the consumer is a deadbeat, deserves to be trashed, and deserves paying higher rates. Yet "health care costs" continue to rise. In other areas, such as construction, there are standard protocols that have evolved to ensure that the general contractor has paid the subcontractors and suppliers, that any mechanics liens have been released, or it is too late to file them, with a payment amount held back until all liabilities are satisfied and the complete job is done. To the extent that insurance companies have a contract with "in network" providers regarding rates and timely billing, at least some legal protections exist, but the consumer depends on the insurance company to enforce them. How can an informed consumer pro-actively protect themselves from medical billing errors? How do you know even what doctors saw you, when you might not even have been awake or concious? Perhaps after leaving the hospital, send the hospital a written demand for a timely summary (within 30 days) of all independent contractors or service providers from which billing may be expected? Insurance companies expect to have all bills submitted within a timely period, or under contract, they can refuse payment, and the contracting doctor is out the bill. Most businesses expect timely billing. Why should the consumer be on the hook for bills sent months or more late, undermining the payment arrangements they have responsibly made under insurance or medical reimbursement plans? I may be paranoid, but they are out to get me. They just don't know it.
Well, this letter is filed away for the time-being... I was told by the Dr's office to call them... As soon as I said which was the Primary insurance they said the #, so *THEY* KNEW the insurance info, they just decided HMO trumps the other insurance, despite the HMO clearly being labeled "PAYOR OF LAST RESORT!" They said they'll put it through again tomorrow morning. If I get another bill, since I now know that they had the primary insurance information all along, then this letter will go out. Nothing like hearing from the horses mouth that the provider did in fact provide them with the insurance information...
