i'm angry, scared & need advice

“i'm being billed by a doctor for treatments i was given over 2 years ago. i've talked with the Dr.'s office in the past, and have been consistently told by my insurer that i'm not responsible to pay these bills. nevertheless, i'm in collections now and am being threatened with legal action to collect about $1200. i just got off a conference call with the collection agency & my insurer. the collection agent wanted my phone number, and when i told him i didn't think i should give it to him, he got angry, said i could deal with his lawyer, and hung up. my insurer is going to fax a copy of the Dr.'s contract to them, including the section that states a Dr. can't bill a patient for portions of the bill that the insurer denies.

i'm shaking all over, and even though i'm sure my insurer is correct, i'm still scared. does anybody know where i can go to look up my rights? are there state agencies that deal with this kind of situation? i'm just so scared and angry. thanks for letting me vent this, even though it hasn't made me feel any better.”

“Tar, I work for an HMO. I might be able to give you some general advice or point you to some sites that might help... What state are you in?”

“i'm in California. sorry, i should have mentioned that.”

“Ah, Then we're neighbors! What insurance company do you use?”

“actually, i'm not with this insurer anymore, but they've been a tremendous help nonetheless. it's Aetna.”

“Okay. First, I think that once they fax the copy of the contract to the collections company, the collections comany will have to kick it back to the provider. You need to find out if they have reported this debt to a credit agency, and if they have, you probably should hire a lawyer to deal with the collection company unless you're interested in a dozen more phone calls like this.

If they have not reported this debt, then they probably have their own doubts about the validity of the debt and were just hoping to intimidate you into paying it.

More in a second...”

“Nolo has a good section on your rights under the fair credit reporting act, and how to deal with #&%!$ collections agents like the one you just got off the phone with. You should read it and know your rights. Also, I would record any future conversations with the collections company.

Let me know if you need more info.”

“i shouldn't have ignored this for so long, but i had already been through this with the Dr.'s office a year ago, been assured by Aetna that i didn't have to pay, and so assumed that the collection notices had no teeth. then the letter came from the lawyer and scared me, as it was meant to do.”

“A hopsital kept calling my wife over a payment like this, they were claiming $16,000 for a service her insurance covered. She just kept refering them back to the hospital. Apparently if the serivce provider doesn't bill the insurers in time then they don't get the money. It sounds like the doctor's office has messed up and they are now harrassing you for the cash. Phad will know much more about it than I do though.”

“thank you Phaedrus, thank you so much.”

“yes ynami, there was at least one claim that was denied because they filed it too late. i hate confrontation, i'm no good at it and it gets me all shaky.”

“Also, if push comes to shove, you can sue them for harrassment, since they have no legal standing to try to collect this debt from you. Keep a written account of all the time you spend on the phone with them, answering letters, and talking to reporting agencies based on this claim, so you can charge them for it later.”

“wow, the NOLO site says they can't add interest, but they've added over $200 in interest charges. hmmm.”

“If the debt were a legal debt, they could charge interest, but you are not liable for this claim!

Can a collection agency add interest to my debt?
Yes. The FDCPA allows a collector to add interest if your original agreement calls for the addition of interest during collection proceedings or the addition of such interest is allowed under state law. Every state authorizes the collection of such interest.
”

“does the HMO you work for also prohibit contracted Dr.'s from pursuing patients for denied claims?”

“That's the general rule. Certain groups have differing coverages with certain providers.

Generally, though, in most contracts I've seen, the only things a patient can be charged for are elective procedures and copayments.”

“I had a similar incident a couple years ago when I was contacted by a collections agency for a hospital bill that they claimed was never paid and was a couple years old. In the end it turned out the hospital had submitted the claim to the wrong insurance company. My insurance company said the hospital would have to resubmit the claim to them, but the time allowed to submit a claim for the procedure had passed and they would probably not be paid. They said that no matter what I would not have to pay anything because I was not responsible for their carelessness. They still took me to court but I had received copies of the claims they submitted to the wrong insurance company. I showed these to the their lawyer in the court room before things got started and she decided not to pursue it. I didn’t pay a dime.”

“and for an elective procedure, a patient would probably have to sign something to that effect, yes? 'cause i worry that they'll come after me and claim that the treatments were elective, which they WERE NOT.”

“In this case...I would work with the insurance company (payor) to tell me what the contract said at the time of service. Then look at the original bill to make sure the provider was paid accordingly.

If the provider was paid what they "agreed" to accept for the service then no more money is due. If there was no contractual adjustment (discount) between the payor and provider then the patient would be responsible for the difference between what the total bill was and what the payor paid.

Yes, if the debt is legal and has just cause, then the provider can charge interest and apply penalties.

Remember this, the provider and the collection agency are not the experts when it comes to what the payor will or will not pay for. Only the payor can tell you for sure what is covered and what is not. Find out how much they paid the provider and then subtract that amount from the bill total. You'll end up with the amount you owe, or the amount the provider agreed to write off.

Now you just need to figure out if the provider originally agreed to write off the difference or to bill you for it.

I do this everyday for a living folks...it sucks.”

“No, Tar, this happens often, but the provider usually doesn't TRY to charge the patient.

Editig software kicks out all sorts of claims by physicians, that the HMO won't pay for according to their contracts.

For instance, say a physician charges the standard claim for an appendectomy, and then tries to charge separately for the incision for the appendectomy - The incision is incidental to the procedure he has already claimed, so the incision claim is denied.

It's usually an administrative error on the part of the physician, and they don't normally attempt to get someone to pay for it.

Just a little background for you.”

“Can you report this to the BBB in Cali?”

“Dunno. I would imagine so.”

“i was assured by the Aetna representative that the Preferred Provider contract prevents the Dr. from "balance billing" the patient. am i correct in assuming that means the Dr. can't pursue me for the remaining balance of any bills submitted?”

“Yes. That means that some of his charges were edited out in accordance with the contract he has with Aetna. He is trying to bill you for those charges, which he has no legal right to do.

I really surprized that he's being so persistent. Have you contacted the doctor directly?”

“It could be just a mistake that they could take care of from the doc's office, if they accidentally referring you to the collector...”

“"accidentally referred"


I'm trying to do too many things at one. :)”

“You work for an HMO? How creative...very insightful.”

“I went to a doctor who after examining me said that the insurance company would only pay him so much for the visit and he asked me if I would be willing to pay him extra out of my own pocket. I told him not a chance and went and found another doctor.”

“You knew that already, bacpac. Or has the alcohol boiled your memory?”

“Believe it or not I don't spend much time thinking about what you do.”

“oh no, it's no accident. they want that money from me.”

“the Dr.'s office won't speak with me now. they told me i have to deal with the collection agency.”

“they are out of line at the doctor's office. Surely there's somewhere you can report them to?”

“we could begin a trail talk policy and all call up the collector's and doctor's offices and bombard them with pointless requests? If we can't beat them then we can at least annoy them.”

“Tar, have you gotten a copy of your credit report lately? Is this on it?”

“no, i haven't. how can i obtain a copy of my credit report?”

“In my state there is a consumer affairs office under the attorney general.

Don't let this stuff tear you up tarbubblebaby. Winning a little battle like this is a lot of fun.”

“My post was about where to get legal help, not a credit report.”

“thanks violin. i'll try to look at it that way. and you don't have to type out the whole belaboured name - tar or tarbubble is just fine. gotta remember to shorten it sometime!”

“You can get your credit report from a number of places online for a small charge. The free credit report places tend to sign you up for a service that's hard to cancel. It's easier to pay he 8 bucks or whatever.

Just do a yahoo search on "personal credit report". You'll find a number of sites.”

“If the collection agent hung up on you, he violated the Fair Debt Collection Practice Act. Complain to the Federal Trade Commission and the California Secretary of State.”

“Tar, Phaedrus has given you lots of good advice. Hang in there.

:)”

“Chili, is that right?!? That's great!

Of course, he can also deny hanging up.”

“Start taping all your phone calls with the collection agency. You have to tell them you're taping all your calls, but you should do it anyway.”

“OK, i just bought my credit report from Equifax. clean a s a whistle, except for a $51 charge from 1996 that was part of the identity theft nonsense, got cleared up, and shouldn't be on there anyway. LOL, what a putz that guy at the collection agency is!”

“oooh Chili, can you give me page or paragraph number on that Debt Collection Act? he was being recorded by the insurance company, or at least they informed him that the call "may be recorded."”

“i thought HMO's were all evil greedy monopolies......


hmm.... now i'm puzzled”

“they're businesses. unfortunately, they're businesses that deal in highly emotional arenas - money & health.”

“you know, he may have made an additional violation of the Collection Act. while we in the conference call, he stated that he had a copy of my credit report and he knew i was a person who didn't pay her bills or some nonsense like that. that's a total lie, i'm looking at my credit report right now, AND he said that while on the phone with my insurer, with the agent listening.”