Medical Collections Discussion

Hi Gang,

One of the most prevelant collection problems on this board continues to be Medical Collections.

I began my homework extravaganza into this subject by going to the following website: http://www.sharonkay.org

I made contact with them and they sent me a private email with the "10 Tips" for handling medical debt, posted below. They sell a book for $30 which I baought but do NOT recommend at this point. Read on and will be clear as to why.

Well we've begun discussing this issue again and I finally may have some answers.

I'm moving some of those posts over here so the discussion will have it's own thread. I think we need work on this until we can get it nailed.

Next are the "10 Tips"

 

Ten Quick Tips on How to Validate or Reduce Healthcare Charges



Thank you for inquiring about the Sharon Kay Foundationâ??s Medical Debt Credit Protection and Repair Manual. Our purpose is to educate Americans on our healthcare rights as individuals and help those in need of reducing their medical debt burden. In a recent report to Congress, Medicare determined that least 11% of medical bills it audited were improper or fraudulent. Please read our 10 easy steps on how to reduce outstanding and future debt associated to healthcare services in the United States:



1. VALIDATE ALL THE CHARGES ON YOUR MEDICAL BILL. If you can only do one thing, do this: Verify all charges and make sure that the services documented were rendered and the products listed were delivered. Request a copy of all fees and explanations from all healthcare providers for services including date, time, and whom services were performed by. If charges or services do not match - there could be a mix up in your billing, making some of the debt invalid. There are all kinds of things that can affect how a medical service is charged. For example, depending on the healthcare service code the billing department put on your charge, you can get charged much more for the same service. Find out what that code really means. Find out if what the doctor actually put on your medical record as documentation actually supports the increased fee for this service. This practice, known as â??upcodingâ?, is mentioned by Medicare as a frequent cause of improper billing.

2. DETERMINE WHAT THE GOING RATE IS FOR MEDICAL SERVICES IN YOUR AREA. In medical billing lingo, determine Usual and Customary Fee Reimbursement. With your medical bill in hand, contact your State Board of Insurance. They will know the usual and customary fee reimbursement schedule for your city and state. Insurance companies pay based on usual and customary. For example, if your doctor charges $100 and usual and customary is $80 then your insurance will pay depending on benefits, 80% of $80 not $100. The remaining balance is your responsibility. Use your insurance as your auditor - only pay for services based on usual and customary fees, using their report as supporting documentation.


3. REQUEST A COPY OF YOUR CREDIT REPORT. Did you know that medical charge-offs CANNOT be put on your credit report without your express written authorization? It is an outright misconception that the Assignment of Benefits (the document which requires the signature of the person responsible for healthcare payments if the insurance company doesnâ??t pay) acts as an authorization for the collection company to release healthcare related information (e.g. medical bills) to credit reporting agencies. It doesnâ??t. Authorization must be obtained by and between the individual whom the healthcare services pertain to and the collection company trying to resolve the outstanding debt. If this authorization has not been obtained, notify the credit reporting agency, your healthcare provider, and collection companies in writing. Inform them that they are in violation of the Fair Credit Reporting Act. Request to have these marks removed immediately.

4. REQUEST A SECOND OPINION from healthcare provider of your choice. Second opinions allow you the opportunity to validate the necessity of services rendered or to be rendered. If the second opinion is different, this shows discrepancy. Documenting this decreases the validity of the services.

5. CONTACT YOUR LOCAL CHAMBER OF COMMERCE and request a list of organizations that assist individuals enduring financial hardship due to healthcare related situations. There are organizations in every city and state that can help reduce the amount of outstanding medical debt. It simply takes a letter for most and they will help with small contributions. Multiple small contributions can make a difference.

6. REQUEST TO SHOP AROUND FOR ANCILLARY SERVICES, if time permits. Ancillary services are typically healthcare services referred out of your doctorâ??s office such as M.R.I., CT scan, Physical Therapy, and medical equipment. You are the consumer and these services are offered by many whom are competitive in pricing and will offer added incentives, such as transportation or resources for the indigent.

7. LOOK AROUND FOR HOSPITAL CHARITIES that support the financially challenged with life threatening conditions. Some hospitals can remove outstanding balances for services previously rendered with in their facility or facilities based on your previous year income and other outstanding medical debt. These programs were created to help those that are faced with medical problems.

8. GET HEALTH INSURANCE. Insurance coverage will definitely help reduce household healthcare cost and protect you from further debt associated to healthcare. Believe it or not, insurance coverage is more cost effective today than ever before. The work associated with validating healthcare transactions accounts for a large portion of insurance companies cost. In most states insurance coverage begins immediately. There may be restrictions on coverage issues regarding pre-existing conditions, but there are many to choose from. But be vigilant - remember to keep your insurance provider in check. Insurance companies come and go, or get bought and sold. Do not let yourself be the surprised one, keep tabs on your insurance providers. If your employer is responsible for these benefits, keep tabs on them as well. If your company declares bankruptcy and cancels your insurance, you may not qualify for Cobra if you get laid off.

9. COMMUNICATE AND DOCUMENT. Communication is a must to resolve any problem, especially a healthcare related debt. Document any and all communications. Documentation is your best tool for defense. If itâ??s not documented, you arenâ??t required to pay. Request as much information as you can, regarding your healthcare services past and future. Knowledge is power.

10. BUY THE BOOK â??MEDICAL DEBT CREDIT PROTECTION AND REPAIR MANUALâ?. If you havenâ??t experienced it before, dealing with healthcare billing departments, insurance companies and collection agencies can be quite exasperating and time-consuming. Let our BOOK do the work for you.


We understand the hassleâ??s associated with resolving healthcare related debt. These steps have been proven to work. All the steps will reduce your household healthcare cost and six of the steps can stop harassing phone calls. Remember: you are the consumer and you have rights! Use them or lose them.

 

I do not recommend the purchase of their book. After I bought it I noticed there were many legal assertions that were not backed up with law. Most of it was just a reprint of the FCRA.

I emailed several times and asked them to clarify those items and only got one response, basically telling me that the Bankruptcy Reform Act was improperly used and that they would delete it. They still have never done so. That was 2.5 months ago.

So I don't believe this book is adequate for our purposes. We all want the law that backs up what we do.

I do think these "10 Tips" ARE on the right track though.

The problem is we will have to dig through the law ourselves and pluck out the applicable provisions.

You will want to go to:http://consumers.creditnet.com/straighttalk/board/showthread.php?s=&postid=218961#post218961 to catch up on the beginnings of this discussion. CaliGirl has made some valuable contributions, among others.

Apologies to Jenasea9 for highjacking her thread.



Are you up to the challange???

 

Sounds promising doesn't it???

The legal reference for this assertion was reported to me to be the FCRA

§ 603. Definitions; rules of construction [15 U.S.C. § 1681a]

(i) The term "medical information" means information or records obtained, with the consent of the individual to whom it relates, from licensed physicians or medical practitioners, hospitals, clinics, or other medical or medically related facilities


AND ...


§ 604. Permissible purposes of consumer reports [15 U.S.C. § 1681b]

(g) Furnishing reports containing medical information. A consumer reporting agency shall not furnish for employment purposes, or in connection with a credit or insurance transaction, a consumer report that contains medical information about a consumer, unless the consumer consents to the furnishing of the report..


These are the only 2 referrences to "Medical Information" in the FCRA. They also told me it was covered by HIPAA and GLBA. Then they told me where I could find them.

THE WHOLE THING!!!

LOL



An issue which I am working on, albeit slowly. lol

The Fee Agreement we sign when requesting medical attention states that you consent to info forwarding to any party needing to know in order to administer or collect the acct., the assignee.

That agreement seems to progress thoughout the chain clear up to the CRA, regardless of how many CA's may be involved. There may however be a problem with the CRA making this information available to an inquirer.

Since I found this stuff out I kinda put the whole thing on the back burner for now. By all means examine the HIPAA and GLBA. Let us know what you find out.

I am especially interested in medical collections.

Somebody look up 45 CFR 160-164, and paste it here.

 

Oh that's ok Manequinne. I moved the medical discussion here cause it needs it's own thread. IMHO.



As far as this being a good post I have to somewhat disagree because it's only a good start. It sounds more promising than it really might be. We have TONS of work to do on this one.

 

LOL I didn't mean all 1000 pages.

HIPAA governs "Individually Identifiable Information" (IIHI)

http://squid.law.cornell.edu:9000/cgi-bin/get-cfr.cgi?TITLE=45&PART=164&SECTION=501&TYPE=TEXT


[Code of Federal Regulations]
[Title 45, Volume 1]
[Revised as of October 1, 2001]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR164.501]

DEFINITION:

Individually identifiable health information is information that is
a subset of health information, including demographic information
collected from an individual, and:
(1) Is created or received by a health care provider, health plan,
employer, or health care clearinghouse; and
(2) Relates to the past, present, or future physical or mental
health or condition of an individual; the provision of health care to an
individual;or the past, present, or future payment for the provision of
health care to an individual; and
(i) That identifies the individual; or
(ii) With respect to which there is a reasonable basis to believe
the information can be used to identify the individual.

You owe $500 to XYZ Hospital. The amount of the bill or your name are not in the definition of Individually identifiable health information. When your bill is associated with your name it becomes IIHI.

 

Well... narrowed down somewhat.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

http://cfr.law.cornell.edu/cfr/cfr.php?title=45&type=subtitle&value=A

Pertinent sections about medical information privacy

160 General administrative requirements
162 Administrative requirements
164 Security and privacy

i'm goin to sleep now.

 

Dear Jenasea9,

The concept of fighting a medical collection based on lack of consent is new territory and provides a another layer of complexity to all this.

Everyone needs to begin at the beginning. Until one has become intimately familiar with FCRA and FDCPA there can't be a foundation for more complicated research.

For example:

§ 809. Validation of debts [15 USC 1692g]

(b) If the consumer notifies the debt collector in writing within the thirty-day period described in subsection (a) that the debt, or any portion thereof, is disputed, or that the consumer requests the name and address of the original creditor, the debt collector shall cease collection of the debt, or any disputed portion thereof, until the debt collector obtains verification of the debt or any copy of a judgment, or the name and address of the original creditor, and a copy of such verification or judgment, or name and address of the original creditor, is mailed to the consumer by the debt collector.

The debt collector MUST obtain verification of the debt FROM THE ORIGINAL CREDITOR and then forward same to the debtor.

This prevents the CA from "dunning the wrong person." This is a very specific procedure and requires the collector to reaffirm your identity with the OC.

It is clear that by what you've described IS NOT PROPER VALIDATION! Keep in mind this pertains to this one account. You apparently have several.

Your next step, IMHO, ought to be a form of Estoppel and demand to remove the item from your CR. CRRR of course.

Here is a rather eloquent post form Sassy:

"That's where Spears v Brennan comes in, the appeal is a 2001 case, and says that a copy of the contract alone isn't enough and details what would be an itemized accounting to substantiate the total amount he is claiming you owe -- which is just what you asked for.

You need the contract to establish that there was an agreement; the terms of the agreement to know how they calculated what they claim you owe; and with the identifying information to show that you are the right person.

The contract by itself is not enough, you need it with a complete itemized accounting to substantiate what the CA is claiming you owe.

AND, you need those records from the original creditor, not the CA, because when you ask for validation it's pursuant to the FDCPA requirements, and it's not enough that you get a computer statement from the CA because they have no first hand knowledge of the debt -- that's the FTC Wollman opinion letter. They have to go further to the original records to be sure that you are the right person and that their records are correct.

If you put all 3 elements together, that's validation -- one part can't stand alone.

You could ask him for documentation proving that they purchased the debt, as well. You never had an agreement with him or his company, if you had an agreement, it was with the original creditor. I could say I bought your debt too and it's not hard to come up with a computer print-out to show whatever I want it too ;-)

Sassy [/B][/QUOTE]

 

If one signs an authorization, the authorization itself must contain certain eliments to be a "VALID" authorization:

[Code of Federal Regulations] [Title 45, Volume 1] [Revised as of October 1, 2001] From the U.S. Government Printing Office via GPO Access [CITE: 45CFR164.508]


PART 164--SECURITY AND PRIVACY--Table of Contents Subpart E--Privacy of Individually Identifiable Health Information Sec. 164.508 Uses and disclosures for which an authorization is required. (1) Core elements. A valid authorization under this section must contain at least the following elements: (i) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion; (ii) The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure; (iii) The name or other specific identification of the person(s), or class of persons, to whom the covered entity [[Page 700]] may make the requested use or disclosure; (iv) An expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure; (v) A statement of the individual's right to revoke the authorization in writing and the exceptions to the right to revoke, together with a description of how the individual may revoke the authorization; (vi) A statement that information used or disclosed pursuant to the authorization may be subject to redisclosure by the recipient and no longer be protected by this rule; (vii) Signature of the individual and date; and (viii) If the authorization is signed by a personal representative of the individual, a description of such representative's authority to act for the individual. (2) Plain language requirement. The authorization must be written in plain language.

My guess is that your authorization does not contain ALL of these "core elements." Even if it does note (v) above. A statement must be included instructing you that you can, in writing, revoke said authorization. Did you read that? lol I've signed authorizations at MP's offices before and I don't remember seeing this.

If you study the entire section that covers the authorization you would also see that it's usable up to and until:

(5) Revocation of authorizations. An individual may revoke an authorization provided under this section at any time, provided that the revocation is in writing, except to the extent that: (i) The covered entity has taken action in reliance thereon;

Though you may revoke your authorization at any time the revocation does not apply to whatever the MP has already done in reliance upon the authorization.