Help! Dr's, Insurance, and Collections

[wildblue 7]

Back in October I get a call from a collections agency saying I owe some doctor $800 - of course, I'm slightly confused by this as I have had medical insurance for the past 6 years. I'm not sure if it's a requirement of the job, or a product of the job, but collection people just aren't nice at all. Rude, unhelpful, etc etc. We went around with two of three different stories about what they could or couldn't do - my insurance company said to just have the collection agency bill them and they'd take care of it, the agency first said they would, then they wouldn't. After much digging from them, I found out who sold them the debt and tried to contact them - luckily I know a few people in the medical field, and got the number of the company that does their billing. So I call them and ask about it. They said they didn't have any insurance information for me at that time, and they sent out a notice to me saying something along those lines. For whatever reason, they had my zip code wrong - so I never got anything from them about it all. So back to the insurance company I go. They tell me to just have them submit the claim again and they'd take care of it. It gets submitted twice, and denied twice. Now, the insurance company says it's been more than 15 months since the date of service, so they won't pay it, and it's the Dr office's responsibility. So I've been dealing with this crap for almost 3 months now - something that should have been dealt with 21 months ago! It's frustrating because no one cares about this except me - and I'm probably the least responsible party in the group.
First of all - if the collection agency calls me again, I'm thinking of writing a "drop dead" letter (once they get the letter, they're no longer allowed to contact you except to explain what further action they plan to take) - is this a bad idea? They're just annoying at this point, and don't listen to anything I say, and everytime they call they just keep offering to set me up on a payment plan. Second - who/what should I be talking to? I can never seem to get the Dr's Office on the phone or to return a call (I have to call 3 or 4 times and bug them) Aside from telling me two different stories, the people at the ins. co. have been somewhat helpful, even offering to talk to the Dr Office with me - of course, I couldn't get them on the phone with us.
Am I wrong in thinking I shouldn't have to pay this?! I've had insurance for 6 years. There were probably $9,000 in claims at that time - no one else had a problem submitting it to my insurance. And I even have an invoice from the hospital for my $50 co-pay - so they didn't have a problem with my mailing address either. If the Dr's office won't write it off, do I just let the collection agency take me to court over it and explain it to a judge? Is that what they'd do next? What does that do to my credit? If it was $50 or something, I'd just pay it so I wouldn't have to worry about it. But I think $800 is worth fighting over. Any ideas? Insight? People with access to high explosives?

it's like incest - you're substituting convenience for quality

[Nightingale 0]

CALL A LAWYER.

A lot of times, something like this can be solved with just a phone call or letter by an attorney to your insurance company.

[weegegirl 2]

I don't have the explosives for you, but I can sympathize.

After a hard opening I had last year, I ended up going to the ER to try to get some pain killers and make sure there was no serious damage. I had health insurance and it was covered.... apparently. Though I keep getting bills sent to me from the hospital for random fees associated with that incident.

Question... how come after you take care of the bill, months later, they are STILL coming up with shit to charge you for????

[Vallerina 2]

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- who/what should I be talking to?

The insurance company. Don't call the special 1-800 number they give you, because nobody there will know how to handle "special claims." You could either search their website for a human resources number, or you could just keep asking for everyone's supervisor. Or, you could try to find the number for their "special investigation unit claims."

You could search online for a consumer advocacy group that may have more information as well. I'm guessing you can't take them to small claims court since it's under a grand.

Adding on...I forgot...Jenny's a paralegal, and the attorneys that she works with deal with insurance. I could e-mail your story to her. She should know how to handle it.

There's a thin line between Saturday night and Sunday morning

[skydiverbrian 0]

For what you'd pay a lawyer, you could just pay the bill.

Collections people are assholes. But they have calculators. Offer them half to settle the debt. It's far cheaper and easier than trying to argue for months and months and/or take you to court to collect.

In a world full of people, only some want to fly... isn't that crazy! --Seal

[Nightingale 0]

Lawyers are typically $200-300 an hour. Most don't charge for the initial consultation to tell you if you have a case. It'll basically be a few minutes with the lawyer, and then a paralegal will write a letter or make a phone call. Then, you can petition to recover your legal fees from the insurance company, because they are the ones who screwed up.

If you just pay the debt and don't dispute it, it can become a very negative blot on your credit report. An account sent to collections can negatively affect your credit for many years.

[nightjumps 1]

According to your profile, you live in Ohio. If that is still the case, you can submit a complaint to the Ohio Department of Insurance (most states have an insurance regulatory agency).

My suggestion would be to fill out a complaint form (located on the website), formalize a chronological letter of events and steps you've taken to resolve the issue. Send a letter including the complaint to the ODI to all parties including the collections agency.

http://www.ohioinsurance.gov/Newsroom/scripts/Release.asp?ReleaseID=840

Hope that helps.

[Vallerina 2]

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If that is still the case, you can submit a complaint to the Ohio Department of Insurance (most states have an insurance regulatory agency).

All states do! I wouldn't recommend that if he wants to get it settled quickly. They may take up to 90 days before they even read his complaint (I've never dealt with Ohio, so I don't know what they're like.)

There's a thin line between Saturday night and Sunday morning

[wildblue 7]

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According to your profile, you live in Ohio. If that is still the case, you can submit a complaint to the Ohio Department of Insurance (most states have an insurance regulatory agency).

But the ins co has a policy that they don't pay claims submitted more than 15 months after the service date - and I can understand their reason for that. Isn't it actually the Dr's Office that screwed up because they didn't submit it back then?

it's like incest - you're substituting convenience for quality

[Vallerina 2]

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But the ins co has a policy that they don't pay claims submitted more than 15 months after the service date - and I can understand their reason for that. Isn't it actually the Dr's Office that screwed up because they didn't submit it back then?

I'm pretty sure they still have to pay the claim. I know that we still pay claims even if they've been submitted 2 years after the incident. They go into the special investigation unit. Then again, I've never actually looked at laws in Ohio, but in about 15 other states, you have to pay a claim if the person was covered by insurance at the time.

Adding on: the reason that they will not just automatically pay it is because they have to look into if you actually had insurance at the time. It's no longer just standard procedure after you wait that long. They should still pay it, but they'll probably have people hound you and the doctor about why it was late.

There's a thin line between Saturday night and Sunday morning

[nightjumps 1]

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I wouldn't recommend that if he wants to get it settled quickly. They may take up to 90 days before they even read his complaint (I've never dealt with Ohio, so I don't know what they're like.)

That was my recommendation. I'm sure other recommendations would be welcome.

[WFFC 1]

Had an issue very similar to this several years ago, although the Drs billing agency never sent a bill (and admitted it). The initial submission was denied by the insurance company due to length of time, but once I got in touch with a someone at the insurance company and the Drs billing agency and got them talking, they took care of it. You'll need to try to remove the collection agency from the process. They don't care what you owe or your story. They want the money so they can get their cut. If you need other ideas, pm me.

[AntiPinkChrissy 0]

I use to work in Benefits in Human Resources and Claims Resolution somehow weazled its way into my job description so here is my experience with dealing with getting claims paid. And you are right, anyone dealing with claims are NOT friendly nor helpful.
First, your Human Resource representative at your workplace should be the one taking care of this. They have specific contacts that would help things get resolved quicker. Any paperwork/information you can give them is really helpful. If they are not helpful, this is what you can do.
The collection agency should provide to you who sent you to collections. Call the facility, ask to speak to someone regarding a claim. This should be the billing office and request an itemized statement for that date of service. Call your insurance company and find out where to fax a claim. Whenever you speak to anyone, get their name and time you called. Fax in the claim, call and confirm receipt. Call back in a few days and find out if the claim was paid.
As far as them not paying because it was not submitted 15 months from the date of service. You probably need to provide proof of timely filing. You can call your doctors office, or whoever put you in collections and ask them where they billed your claim to, they should be able to do a print screen that shows proof that they billed your insurance company in a timely manner.
If your insurance company is denying the claim, they should be able to give you a specific reason why. Exactly what is covered by your insurance company should be covered in your SPD (Summary Plan Description).
Usually the items that get misbilled are tests that you get done in a hospital because the lab doesn't know where to bill it.
This is all a pain in the a**, believe me I know.
I hope this is helpful, there are so many little things that can get a claim denied it is rediculous. But you must be persistant!
PM me if you need to. I am more then happy to try to help.

Blue Ones
Chrissy

~La La Gang Member #2~

[wildblue 7]

Thanks - I've been pretty much doing what everyone has suggested so far - it's just frustrating because I'm not getting anywhere. I actually just got off the phone with the Dr's Office (actually, their accounting group) who originally screwed all this up. They are, or course, claiming I'm SOL - they claim they didn't have my insurance information, they claim they tried to get it and couldn't (back to that having the wrong address problem) which is really annoying because no one else had a problem getting my information or submitting a claim. She kept saying "Well you're responsible, you recieved the services" - uh, yeah, how was I supposed to know someone was going to screw up and not give my information or correct address?!
I have an address now to make an appeal to my ins co - we'll try that I guess.

it's like incest - you're substituting convenience for quality

[Vallerina 2]

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She kept saying "Well you're responsible, you recieved the services" - uh, yeah, how was I supposed to know someone was going to screw up and not give my information or correct address?!

Because technically, it's true. It is ultimately your responsibilty to make sure that the claim went to your insurance agency. Doctors don't have to file a claim directly there, some won't. So, even if they had your insurance info, they could've still billed you directly. I don't know how it works if they had all the wrong information, though. Hmm...

There's a thin line between Saturday night and Sunday morning

[Michele 1]

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They are, or course, claiming I'm SOL - they claim they didn't have my insurance information

Any way you can get a copy of the file, and see if you had been billed successfully before/after?

Maybe you can have them send you a copy of the intake sheet (or whatever they call it) which shows your information. That way, if there's an issue, you can see where it started - poor handwriting on your part, or bad data entry on theirs (or illegible copy from a machine). Once that's established, then you can dispute the info with your credit report, as well as have a bludgeon to whack them around with, should it show you were not the one at fault for the misinformation.

Also, maybe stop talking to the lower level folk, and start talking to those who can make the decisions.

Good luck -

Ciels-
Michele

~Do Angels keep the dreams we seek
While our hearts lie bleeding?~

[tigra 0]

I had a similar thing happen a couple of years ago, but it didn't get as far as a collection agency. Just a rather large bill I received perhaps 18 months after I had surgery to remove hardware from my ankle. I contacted both the service provider and the insurance company, and the insurance company told me it was the provider's responsibility to bill within a certain timeframe and if they could not prove that they had, they were SOL. I passed that on to the service provider and gave them my insurance info. I never heard anything after that, and I was able to buy a house this year with no blemishes on my credit report, so one way or another it must have been resolved.

However, I also had a terrible problem with a $34.00 bill that got turned over to a collection agency because that same lamea$$ insurance company did not pay the bill, and the service provider refused to communicate directly with them. That took several months and I don't even know how many phone calls to resolve! I'm sure it would have been easier to pay the bill, but by the time I got the notice from the collection agency, I was beyond pissed, AND the insurance company promised over and over again that they would take care of it!

I wish you lots of luck with this! I think its very unfair that an honest person's credit rating can be damaged because of incompetence on the insurance company's part, or because a service provider failed to bill properly.

maura

[AntiPinkChrissy 0]

UGH!! How frustrating! I would definately try to talk to a different person at the Doctor's office, sometimes you just have to try to get the right person.
Did you get an itemized statement (also called HCFA form)? You could try sending that directly to your insurance company. Or are they denying saying that it has been too long? Ask the doctors office for proof of timely filing, that way you at least have proof that the doctors office tried to bill. That is all you have to prove. Even if they have your address wrong, that should help prove your case.
Unfortunatley you are ultimately responsible, but if you annoy the crap out of them, you can usually find a little tidbit of information that can help you out.
Good Luck!

~La La Gang Member #2~

[freefallfreak 0]

Dude,
Find the collection company's address, go to a hunting supply store, purchase a bottle of bobcat/mountain lion lure (large cat piss), find the air intake to the heating system for the collection company's building and dump said bottle. Wait one week, fill out a quit claim form with the collector's name, car make and VIN if you can get it (located on dash of said person's car), submit it to the nearest non-profit/charity organization, sit back and watch the fun.
TripleF
P.S. Don't get caught signing the collector's name to the quit claim deed. It's called forgery, lol, but still funny as hell. In lieu of this being not to your liking, I have other ideas...hehehe

P.P.S. Never underestimate the deviousness of an older person, lol...we just get more experienced with age, hehehe.

"Upon seeing the shadow of a pigeon, one must resist the urge to look up."