Medical Bill in COLLECTIONS ... Yikes!

[tryan]

This saga has been going on for about 6 months. 2 years ago one of us had a 3-4k procedure. The bill was never received by my insurance company (BC/BS). Then when the Dr attempted to bill ME they sent the bill to the wrong address. I received the bill from a COLLECTION agency 6 months ago. Of course, it's loaded with late fees/interest charges ... they now want nearly 7K ... YIKES!!

So I' ve been working to get BC/BS in touch with healthcare provider. Within the last 2 months they are "talking". "We billed you" ... "No you didn't, but feel free to submit it now. We'll review it - then reject it because it's 2 years old".

So the provider rebilled. BC/BS rejects it ... "per contract - too old".

Now the collections people are back on my case. Of course they want nearly 7k ... not the negotiated rate minus bogus interest fees.

I really don't want my credit hit for a problem I didn't cause. But I really, really don't want to flush ~7k to avoid an easily disputable credit hit.

Soooo what wisdom do you all have regarding medical bills in collections? Is there a "statue of limitations" for credit hits (almost in year 3 now)?

 

[MichaelB]

This saga has been going on for about 6 months. 2 years ago one of us had a 3-4k procedure. The bill was never received by my insurance company (BC/BS). Then when the Dr attempted to bill ME they sent the bill to the wrong address. I received the bill from a COLLECTION agency 6 months ago. Of course, it's loaded with late fees/interest charges ... they now want nearly 7K ... YIKES!!

So I' ve been working to get BC/BS in touch with healthcare provider. Within the last 2 months they are "talking". "We billed you" ... "No you didn't, but feel free to submit it now. We'll review it - then reject it because it's 2 years old".

So the provider rebilled. BC/BS rejects it ... "per contract - too old".

Now the collections people are back on my case. Of course they want nearly 7k ... not the negotiated rate minus bogus interest fees.

I really don't want my credit hit for a problem I didn't cause. But I really, really don't want to flush ~7k to avoid an easily disputable credit hit.

Soooo what wisdom do you all have regarding medical bills in collections? Is there a "statue of limitations" for credit hits (almost in year 3 now)?

Sorry to hear this happening.

I would write to the doctor, summarizing the facts, and then dispute your obligation to pay the bill based on the fact that you were insured and it is not your liability if the provider did not bill according to the insurer agreement. I would also confirm that I was willing to pay my fair share after insurance, but also after being correctly billed.

Then I would file a complaint with the State Attorney General and the State Insurance Regulator, forward the complaints to the credit agencies, indicating the bill has been disputed. Then send a letter to the collection agency summarizing all that and instruct them to back off and wait for this to be decided.

 

[utrecht]

Something similar happened to me several years ago. It was a smaller amount though. IIRC the amount was about $700. The doctors office waited too long to file with the insurance company so when they finally did, the insurance company refused to pay. Then the doctors office billed me for the entire amount. I called them and they agreed it was their mistake and they agreed to write off the charges.

Then, about 6 months later I got a call from a collection agency about the bill. I refused to pay it and told them why. They never called me again but it did show up on my credit report. I don't know the formula they use to calculate your credit score but whatever it is, it didn't affect my score by enough to worry about. If your credit score is already marginal maybe it would?

 

[pb4uski]

I think that I would tell them that I would pay them whatever I would have had to pay if they had properly billed it to BC/BS to begin with (essentially the negotiated rate less what BC/BS would have paid) and they can collect that today but only if they waive everything else and then pursue a claim with BC/BS.

In other words, you shouldn't have to pay for their billing mistakes. If they want to be more greedy than that then wait until hell freezes over or a court orders you to pay, whichever comes first.

 

[utrecht]

I think that I would tell them that I would pay them whatever I would have had to pay if they had properly billed it to BC/BS to begin with (essentially the negotiated rate less what BC/BS would have paid) and they can collect that today but only if they waive everything else and then pursue a claim with BC/BS.

In other words, you shouldn't have to pay for their billing mistakes. If they want to be more greedy than that then wait until hell freezes over or a court orders you to pay, whichever comes first.

If you decide to do this, I would get it in writing so they don't go back on their word like my doctors office did to me.

 

[pb4uski]

Good point.

 

[MBSC]

My Blues plan prohibits the provider from billing the member due to timely filing issues. Does your plan have similar language and, if so, is the provider's billing office aware of it? When your plan denied the claim for timely filing, you should have received an EOB. Does it contain an amount under "member responsibility/amount member may be billed?"

BlueCross will deny claims it receives after the timely filing period. The member and BlueCross should be held harmless for these amounts.

BCBSSC Provider Office Administrative Manual (page 56).

 

[Car-Guy]

In the past year I have begun to realize that dealing with medical billing and private insurance companies can be worse than the illness. I'll be going on Medicare next year and I'm not sure what to expect from that (better or worse)?

 

[Walt34]

I'll be going on Medicare next year and I'm not sure what to expect from that (better or worse)?

I just started on Medicare a few months ago. No issues yet, but nothing complex either. We'll see.

 

[MRG]

IMHO billing issues are tough to resolve. The way I've dealt with them is careful attention to my EOBs. When something doesn't get posted call and ask both sides did you send or receive? When I've been nice but persistent eventually they recode the bill properly and resubmit.

SCgamecock, that's a great idea. I know megacorp insurance had that same clause in it. Never checked my BCBS policy.

 

[hnzw_rui]

IMHO billing issues are tough to resolve. The way I've dealt with them is careful attention to my EOBs. When something doesn't get posted call and ask both sides did you send or receive? When I've been nice but persistent eventually they recode the bill properly and resubmit.

SCgamecock, that's a great idea. I know megacorp insurance had that same clause in it. Never checked my BCBS policy.

This is why I like Kaiser. They're both insurer and provider and have all my records. It's also in their best interest to keep me healthy through preventive care so they don't incur higher costs for serious medical conditions later down the line.

My supervisor has BCBS and every day, he's on the phone with both insurance and medical providers trying to resolve billing disputes (his wife has cancer so lots of expensive medications and treatments).

 

[Bamaman]

This is why I like Kaiser. They're both insurer and provider and have all my records. It's also in their best interest to keep me healthy through preventive care so they don't incur higher costs for serious medical conditions later down the line.

My supervisor has BCBS and every day, he's on the phone with both insurance and medical providers trying to resolve billing disputes (his wife has cancer so lots of expensive medications and treatments).

I used to have Kaiser Permanente HMO in Atlanta. They're okay for sniffles and minor health issues. But if you have a serious problem in Atlanta, you may be in a heap of trouble.

My wife had a mass in her uterus, and Kaiser never found it after several years of irregularities and exams. When our company switched to regular BCBS insurance, she had to switch doctors, and the new physician found the problem in one office visit. Surgery was scheduled, and within 10 days the problem was solved without incident.

In retrospect, we realize that HMO's physicians are not the top of their class. But we all know the one that graduated last in his class is still called "Doctor."

Now we have the ability to search out our own doctors. HMO doctors' pay is set partially to customer approval ratings and their ability to avoid referring patients to other outside specialty physicians.

 

[Katsmeow]

IMHO billing issues are tough to resolve. The way I've dealt with them is careful attention to my EOBs. When something doesn't get posted call and ask both sides did you send or receive? When I've been nice but persistent eventually they recode the bill properly and resubmit.

There are a couple of issues though, that I've run into. Just a few currently going on:

1. I had a mammogram in December. Hospital billed and my insurer paid (I was at the point of the year where I had met the out of pocket max for the year).

I recently received a statement showing zero balance from somewhere else but showed $150 or so was pending with insurance. I assumed something was pending with insurance. But, I looked on the insurer web page and nothing is pending. I am concerned now that someone (maybe a physician?) didn't bill the insurer and thinks it is pending and now it is too late to bill and I will get stuck with the $150 (usually these physicians in hospitals are out of network).

2. DD ahd some appointments (ongoing treatment) that required pre-approval. Pre-approval was requested and received (in network provider explicitly was required to do this and did do it). I have a copy showing pre-approval was received.

Provider has been submitted claims and every claim has been denied on grounds services don't match pre-approval. Provider called insurer who said that no pre-approval had been given. Provider sent them a copy of the pre-approvals. Insurer agreed there was pre-approval. Provider submitted again. Denied again. Provider says this can be very common. It is usually something small that the computer doesn't match (the address is slightly different, or the insurer says the provider name doesn't match (due to some very slight difference). Provider says it often takes over a year to get this resolved and for me not to worry about it since I have no responsibility other than my co-payment (insurer actually says we have no responsibility even for the co-payment, although I don't mind paying the co-payment). I have 6 months to appeal a denial but since I have no idea why it is being denied and neither does the provider hard to appeal. And, provider says I don't need to. Of course, my fear is that a year from now if provider doesn't get this straightened out they ask us to pay the whole thing.

3. DD was transported by an ambulance. Charges were submitted and paid by insurance company except for co-payment. Ambulance sent bill for co-payment which was paid a couple of months ago.

Just today I see on the insurer web page that they denied a second claim by the same ambulance company for $25 more than the original charge (each claim was over $1000). EOB says denied because asked company for more info and it wasn't received.

The strange thing is there has been nothing on the web page before today about this second claim by the ambulance company. So, seems weird that insurer said more info was asked for. Also don't know what the second claim is for. There is on the web page a claim show as in process for the same amount on the same day but it seems to be a physician claim (I thought it was for someone at the hospital). So - no idea what any of this is. No bills received from anyone except the one bill for the original co-pay....

 

[imoldernu]

What Michael said.
Always seems to be a lot of extra work to do all the writing and documentation, but this type of a problem can easily get out of hand, and right or wrong, without making the effort the results often end badly.
We have had occasion to bring in the Attorney General for unrelated matters with good result. In our case we did not have the documented dates, copies and record of calls etc, but the fact of filing stopped any further action.
Without making the effort, cases tend to become impersonal and unchallenged rulings invariably go against the litigant.

We have found, once in our own situation and later with neighbors that almost all businesses have an appeal type department. Many years ago, my DW required urgent surgery when we were in Florida, and our HMO was in Illinois. Our Illinois Doctor, who got $200/patient bonus for limiting medical expenses, refused to approve the operation, sayng that we had to get a med flight back to Illinois.... and he would not approve the (eventually) $175K cost of the operation. After many roadblocks we broke through to the Patient Liaison and Enabling Nurse to get the approval. Without persistence on our part, we would have been held liable... or ended up with bad credit. Not easy, but necessary.

Best of luck in settling this.

 

[Texas Proud]

I remember reading recently that medical bills reported will not be used in calculating your credit score... I guess they have determined that there is so much BS in the system that they should not hold you responsible...



I just paid a couple of bills to a collection agency for medical procedures... they were $30 each... I had been looking for EOBs, but never saw them.... come to find out the EOB had the doc name and the bill had the facility name (they were test, so I did not know what was going on)....

I still see a charge of $1600 for some leg pumps that were used to pump blood from my legs when I was put under.... I did not know I did not need them and that I was 'buying' them.... so far the insurance has refused about 5 times.... but they have not yet tried to collect from me... just another money grab IMO...

 

[hnzw_rui]

I used to have Kaiser Permanente HMO in Atlanta. They're okay for sniffles and minor health issues. But if you have a serious problem in Atlanta, you may be in a heap of trouble.

My wife had a mass in her uterus, and Kaiser never found it after several years of irregularities and exams. When our company switched to regular BCBS insurance, she had to switch doctors, and the new physician found the problem in one office visit. Surgery was scheduled, and within 10 days the problem was solved without incident.

In retrospect, we realize that HMO's physicians are not the top of their class. But we all know the one that graduated last in his class is still called "Doctor."

Now we have the ability to search out our own doctors. HMO doctors' pay is set partially to customer approval ratings and their ability to avoid referring patients to other outside specialty physicians.

Guess it depends on location, too. So far, I've been pretty happy with Kaiser in Los Angeles. Granted, have heard some bad things about Kaiser San Diego.

 

[tryan]

Thank you for all your input!!

SCGamecock - Thanx!! I googled my applicable BCBS quide and found this on page 37

Plan is not obligated to pay claims received after this three
hundred and sixty five (365) day period. Except where the member did not provide Plan
ID, Provider or Facility shall not bill, collect or attempt to collect from member for claims
Plan receives after the applicable period regardless of whether Plan pays such claims.

Will call BCBS monday ... the latest EOB put the whole wad in PATIENT BALANCE. This, after stating the bill was submitted too late. Need to get that fixed. Then make the provider aware they are violating this aggreement.

Behooves me to know if my credit score is even at risk. More research needed.

Thanks again!

 

[Sunset]

I've only read of other people having this issue, and another common step is to dispute the charge/bill to the collector, they then have to prove you owe it.
They may not have the paperwork to prove it, and will fail.

One mistake folks make in this situation is to pay a little towards it, based on telephone talk, its a mistake as it resets the clock which has already been running for couple of years now.