Received letter from OC for past due co-pays...

[catlover78]

I received a statement from when I was pregnant back in 2005. I had a number of ultrasounds, and was never told there was a co-pay for them, and they never collected them or asked for them at the time of service. Now, over 2 and a half years later they sent this, asking for $160 in co-pays. Its not in collections, doesn't say final bill or anything. What do I do with it? Am I responsible for co-pays 2 years after the fact?

 

Cat

[Why Chat]

I received a statement from when I was pregnant back in 2005. I had a number of ultrasounds, and was never told there was a co-pay for them, and they never collected them or asked for them at the time of service. Now, over 2 and a half years later they sent this, asking for $160 in co-pays. Its not in collections, doesn't say final bill or anything. What do I do with it? Am I responsible for co-pays 2 years after the fact?

 

Cat

Who is the "they"??

Is it the actual OC or a CA??

 

Are they reporting on your credit reports??

[catlover78]

I received a statement from when I was pregnant back in 2005. I had a number of ultrasounds, and was never told there was a co-pay for them, and they never collected them or asked for them at the time of service. Now, over 2 and a half years later they sent this, asking for $160 in co-pays. Its not in collections, doesn't say final bill or anything. What do I do with it? Am I responsible for co-pays 2 years after the fact?

 

Cat

Who is the "they"??

Is it the actual OC or a CA??

 

Are they reporting on your credit reports??

 

It the OC. Nothing on my reports for it.

 

Cat

[Why Chat]

Check with your insurance Co. and see what they paid for this and what your expected "co-pay" was ( if anything).

 

It is possible/probable that this is NOT a "co-pay" but the discounted amount from the insurance, as required pre-natal care is usually covered 100% on most policies.

 

( I am assuming the ultra sound was required by your OB/GYN and was not a "photo-opportunity" ultrasound)

[catlover78]

Check with your insurance Co. and see what they paid for this and what your expected "co-pay" was ( if anything).

 

It is possible/probable that this is NOT a "co-pay" but the discounted amount from the insurance, as required pre-natal care is usually covered 100% on most policies.

 

( I am assuming the ultra sound was required by your OB/GYN and was not a "photo-opportunity" ultrasound)

 

Thanks. I will contact the insurance first.

 

They were required because of suspected problems, definitely not just to look at the cute baby

 

Cat

[catlover78]

Ok, I checked with the insurance company, and I do owe these co-pays because the care was outside of my "global care" system for maternity care. So, how do I handle this? I can't afford to send them the whole $160.00 in one shot, should I send them what I can afford and a detailed payment plan with all the payments? Is there a certain letter I should send to make sure this doesn't go to collections while I am paying the OC?

 

Cat

[Why Chat]

Ok, I checked with the insurance company, and I do owe these co-pays because the care was outside of my "global care" system for maternity care. So, how do I handle this? I can't afford to send them the whole $160.00 in one shot, should I send them what I can afford and a detailed payment plan with all the payments? Is there a certain letter I should send to make sure this doesn't go to collections while I am paying the OC?

 

Cat

What do you mean when you say you "checked" with your insurance Co.??

Had they paid ANYTHING to this OC on the account??

Where were your OTHER sonagrams done??

 

Are you sure this $160. is a "co-pay"?? It MIGHT be the whole bill if the provider was disallowed.

 

If so, get the itemized EOMB from your insurance to show what they WOULD have paid for that procedure IF the OC had been "within" your global care system.

 

You can pay THAT amount, which is likely less than $80. to the OC with the HIPAA letter insert "a"

[catlover78]

Ok, I checked with the insurance company, and I do owe these co-pays because the care was outside of my "global care" system for maternity care. So, how do I handle this? I can't afford to send them the whole $160.00 in one shot, should I send them what I can afford and a detailed payment plan with all the payments? Is there a certain letter I should send to make sure this doesn't go to collections while I am paying the OC?

 

Cat

What do you mean when you say you "checked" with your insurance Co.??

Had they paid ANYTHING to this OC on the account??

Where were your OTHER sonagrams done??

 

Are you sure this $160. is a "co-pay"?? It MIGHT be the whole bill if the provider was disallowed.

 

If so, get the itemized EOMB from your insurance to show what they WOULD have paid for that procedure IF the OC had been "within" your global care system.

 

You can pay THAT amount, which is likely less than $80. to the OC with the HIPAA letter insert "a"

 

I should have clarified better. These are 8 seperate co-pays, all $20 each totaling 160.00 on one bill. I called my old insurance company who confirmed they paid all other expenses with these visits, but because it was not with my maternity care provider, instead it was with the ultrasound place and their doctor, then the co-pay does apply. It just gets all confusing because I was referred there by my doctor for these tests, and I never paid a single copay for any other test she referred me for, so I don't understand why this is different. But, I'm at a point where I just want to pay what I can to keep it out of a CA and off my reports.

 

Cat

[Why Chat]

I should have clarified better. These are 8 seperate co-pays, all $20 each totaling 160.00 on one bill. I called my old insurance company who confirmed they paid all other expenses with these visits, but because it was not with my maternity care provider, instead it was with the ultrasound place and their doctor, then the co-pay does apply. It just gets all confusing because I was referred there by my doctor for these tests, and I never paid a single copay for any other test she referred me for, so I don't understand why this is different. But, I'm at a point where I just want to pay what I can to keep it out of a CA and off my reports.

 

Cat

OK, I get it now. They only JUST started billing you for these co-pays from 2 years ago??.

 

Here is what you do-- send them the HIPAA letter and use this "combo" I am designing for you in place of insert "a" or "b" MAKE SURE YOU USE A MONEY ORDER AND FOLLOW THE DIRECTIONS:

http://whychat.5u.com/hipltr.html

(Your Name)

(address)

(City,State, zip)

s.s.# (social security #)

Legal Dept.

( health care provider creditor)

(address)

(date)

Dear Sir/Madam;

This letter is in reference to (account #) for services provided to (name of patient) on xx/xx/xxxx through xx/xx/xxxx, ( 8 visits).

 

In regard to the bill on this account in the amount of ($___):

 

Enclosed please find my remittance of $40. at the rate of $5.00 per visit for payment in full of this account.

 

This payment is in accordance with the normal and usual amount of co-pay that would have been due if your billing to me after my insurance payment had been done in a timely manner.

 

Although your billing for these co-pays has been done outside of the allowed billing time under State statutes on fair billing practices, I am tendering the payment to you in good faith.

 

Please note, my remittance is payable ONLY to (hc provider) and may not be signed over or transferred to any third party collection agency, as this would constitute an additional violation of HIPAA and State Privacy Act rules .

 

Copies of this correspondence and a copy of the remittance check may be used for any further actions with State or Federal agencies

 

Please make sure that all of my records are kept from any and all dissemination to any 3rd party collection agencies.

 

Please be advised that under Federal Statutes. the Fair Credit Reporting Act, (15 U.S.C. § 1681 et seq)and (name of your State)'s Consumer Credit Statutes, you may be held liable for the actions of any collection agency.

 

(a) Duty of furnishers of information to provide accurate information.

(1) Prohibition.

(A) Reporting information with actual knowledge of errors.

A person shall not furnish any information relating to a consumer to any consumer reporting agency if the person knows or consciously avoids knowing that the information is inaccurate.

 

In addition, the HIPAA and (name of your State)'s Medical Privacy Statutes are in effect in this situation

 

 

Your furnishing of my account information to any collection agency and/or any subsequent reporting of this account on my credit reports to credit reporting bureaus would be a clear violation of Public Law 104-191 ("HIPAA") since there can be no permissible business purpose in divulging protected health information to anyone on an account once there is no longer any payment due.

 

 

Sincerely,

 

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(Your Name)

Edited November 26, 2007 by Why Chat