More med validation attempts

[superfreak1]

Well, I posted before about receiving my wonderful validation consisting of a statement showing a 0.00 balance crossed out and $55 handwritten beside it. Well, I now have another ignorant CA who thinks they are properly validating.

 

My first issue with their validation is that the itemized statements are only itemized to a point. By this I mean that it lists all alleged services rendered and their cost, but when it gets to payment info it is a handwritten note in the margin that basically says "Ins. Pd- $XX.XX Ins. Discount- $XX.XX Balance-$XXX.XX" Is this acceptable? How do I know insurance didn't pay more then whoever wrote this in is claiming? They are the ones that have to provide this info, correct? Realistically, they could claim insurance only covered $50.00 on a $1,000.00 debt and I'm responsible for the difference if I go by some handwritten notations in the margin. Wouldn't an actual statement include a payment, and possibly the check # they were paid with? Is there anything else that would or should be on a complete statement?

 

My next issue with their validation is that they are not addressing the proper person at times. Let me explain. There are a total of 10 debts that they are putting together. I reqeuested validation on all of them. they attempted validation on all of them. Some are addressed to my wife and I both, some to just her, and some to just me. I am the only provider therefore insurance is provided by me. I would be the guarantor. We have on bill addressed to DW for my daughter. DW would not be liable then, correct? I have another debt for daughter with a bad debt writeoff of $20, an insurance writeoff of $4.00, and a total account balance of 0.00. Patient amount due now:0.00. They claim I owe them (the CA) $20 for that one.

 

All of the other debts are for DW, except 2. One I don't recognize as it is an ER visit and I don't recall going to the ER in the past few years as I rarely even go to the DR. They have failed to prove to me that this is a debt incurred by me. Should I request further validation, such as an admissions slip signed by me for the date on the statement? This debt also lists my wife as liable even though I am the alleged patient, as well as the guarantor. She can't be held accountable, correct? My other bill where I am listed as patient does the same, lists her as liable, even though I was again both patient and guarantor.

 

Any help would be appreciated.

 

 

 

I could use help putting together a 2nd DV letter If that should be my next step.

Edited September 29, 2005 by superfreak1

[superfreak1]

bump for reply from any vets, or others that care to comment.

[genseeker]

The med bills for our DD is under my name. DH is the only one employed and with insurance. However, I was the one who took her to all appts. Her bills have never been addressed to him and no collections for her show on his reports. Wish I oculd offer more insight.

[superfreak1]

WHYCHAT, Cotterpin, anybody......

[Why Chat]

If I hadn't made myself clear before, I will do it again.

 

IMO any "DV" of any kind to a CA on a medical account is a mistake.

 

Send the medical dispute letter to the CRA's.

If verified, send the HIPAA letter ,insert"a"with payment to the OC, or with insert "b"if there is no amount due.

 

Do the follow up dispute to the CRA, and follow up letter to the OC.

[superfreak1]

Ok... I'll be sending out payment asap. I work 55+ hours a week though so it is kind of difficult to get to the post office while it is open. I'll try to get it sent out next Sat.. Could you please explain to my why you think a person shouldn't DV a CA? If you've already explained, then maybe a link to the post? I'm personally glad I did it. There are a few accounts that they attempted to send validation for that have either been paid (by insurance, proven by my EOB's) or have 0.00 balances, but the CA thinks I'll just pay because they wrote in an amount in the margin. My DD was on medicaid, but they attempted to bill my primary ins which didn't cover her at the time so they thought they would force me to pay. Now medicaid will be picking up that tab as I had requested validation, received it, did my research and noticed somebody else was responsible to pay. If I hadn't DV'd I would be out hundreds of dollars more, and it wouldn't really be my bill. These medical practicioners in this state (NE) have a difficult time billing people properly. Currently, I am receiving med bills for my wife who is on medicaid because she moved out. They are supposed to bill my insurance first, and then medicaid picks up the tab. I guess it is just to difficult for the people in billing to send bills out to more then one insurance company as they NEVER attempt to bill medicaid until I get my bill saying I owe them and I correct them and have them bill medicaid. My wife DOES tell them EVERYTIME that she that is on it, but since my insurance is in the computer already I guess it's to much trouble to make a note to be sure to bill the state for the remainder. If I just paid all of these bills without question then I would be thousands of $ in the hole right now and my credit would be even worse off. I just recently caught my son's former DR. double billing. My son is disabled. He did see a DR. in another city almost weekly. They have sent us bills monthly with a balance of 0.00 as medicaid has paid for his visits. Just last week I received no less then 5 EOB's totaling about $2,500.00 for a couple of months worth of visits. Insurance didn't pay because they are past the date in which they will pay. They are paid anyways by the state. we have statements showing 0 balances. Now, had a CA sent me dunning letters for these and I had followed your advice and not DV'd them I wouldn't know what the dates were so I wouldn't be able to research if they had been paid or not. I would have just sent the HIPAA with payment. I would have never known that they had already been paid. Then my family and I would have been out $2,500. This happens more then you would like to think. My DM used to work in the billing debt for a Dr. office. If they made a mistake and caught it after it went out the door they just let it go. If the customer or insurance caught it they would fix it, if not then that would just go in the bank. Medical treatment is expensive if you only pay the bill once. can you imagine paying half your bills twice!?! Imagine how much the providers are making due to the way billing is handled.

[Why Chat]

You misunderstand my post.

 

The medical dispute letter to the CRA is essential to find out if you DO indeed owe anything to anyone.All the CA will provide is what they have either been assigned, or have picked up out of the garbage from written off accounts.

 

They would be unable, (and as you have found out, unwilling) to actually "validate" any medical account, and IF you did pay the CA you would wind up with a "paid" collection on your report.

 

The medical dispute letter, and the HIPAA letter program is designed to :

1: Get CORRECT verification of bills that are actually OWED.

2: Obtain a deletion of "garbage" CA accounts.

3:Pay the OC health care provider directly IF it is determined that there is a legitimate bill owed.

4: Get a deletion of the paid account, instead of having it shown as a paid collection.

5: Keep the $$ out of the hands of the CA and provide you with a legitimate medical deduction for IRS.

 

Please do NOT send any $$ to anyone unless and until you have sent the medical dispute letter to the CRA, you may NOT owe anyone anything.

 

I suggest this method because the HIPAA rules allow you the opportunity to pay the OC directly and obtain a deletion, and/or determine that there is NOTHING owed,and get a deletion of a CA entry.This does NOT apply to other types of debts.

[superfreak1]

thank you for clearing that up.

[cotterpin]

If I hadn't made myself clear before, I will do it again.

 

IMO any "DV" of any kind to a CA on a medical account is a mistake.

 

 

<{POST_SNAPBACK}>

 

I disagree with this. There are times and situations which may call for a DV. An full accounting may be required, or the right to collect. Preventing an account from being reported by disputing within the initial 30 days......

 

Credit repair is not one size fits all, and saying or implying that the "ONLY SOLUTION" is your HIPAA letter is incorrect, as is implying that your method is the only one that should ever be used. There is no cookie cutter solution and your method may 1) not work for everyone and 2) may not suit someone's needs. People are allowed to choose the method they feel.

 

From what I am reading, the OP proceeded properly considering the circumstances.

 

The other option for the OP is to send a 2nd DV, more strongly worded, to the CA. Also, Medicaid is a government program. If the provider was given the proper information to whom they should bill (Medicaid) and they failed to do so in a timely manner, they are not allowed to bill teh patient.

 

Also, you should note that Medicaid is always "payor of last resort". This means if there is another insurance (ie: DS is on your HMO plan), even if it is KNOWN that they won't cover the service, they MUST be billed prior to Medicaid.

 

From what it sounds like, they billed your primary insurance but continually drop the ball after they receive the denial/partial payments.

 

One way to rectify this for the future (if the provider is contracted with primary ins and medicaid) is to have a notice type letter drawn up. Include ALL insurance information and send it to the director of patient accounts and to their respective ivory towers. Advise them you are once again informing them of the insurance coverage, and are basically tired of their incompetence. Advise them that failure to follow the guidelines set forth in their contracts with primary and Medicaid regulations. Advise them that future "errors" on their part will result in complaints to the Division of Insurance, Medicaid, Primary ins, etc for unfair and deceptive billing practices.