WHEN THINGS GO BAD.......

[trix]

I have a medical collection on my CR from FFCC. This is the only baddie left on my CR.

In May 2006 my son had his 2 wisdom teeth removed (I know...strange, but he only

had 2 that grew in). The oral surgeon's office verified our insurance coverage, gave

me the form to sign that showed our co-pay amount of $693.00. They gave me a

copy of the form signed by the provider & myself. I gave them my credit card & paid

them $693.00.

 

You must pay them up front for your portion before they do anything, so thats what I did.

They billed my dental insurance and it was denied. Well come to find out, its not considered

dental if the teeth are impacted and anesthesia is not covered. This office supposedly called

the dental insurance with the procedure info, because they were sure quick to tell me my

what my co-pay was. ($693.00). The dental insurance paid $65.00 for the consultation @100%.

 

So now that its considered medical, it should be filed thru my medical insurance. This of course

is a different carrier than my dental. I contacted the oral surgeon's office with all the info I

received from the dental & medical insurance. I also questioned their verification of insurance

coverage and was told that someone would get back w/ me.

 

I continue to call because I never received a call back w/ an answer to my question. I call again

& this time I'm told that their billing dept (at another location) handles all their claims. So I

call them & give them the info given to me & they said they would take care of it & bill my

medical insurance.

 

I still keep getting bills for $592.00 & I continue to call them asking why are they sending

the bills to me & not the insurance company. They now tell me that they are waiting for the

oral surgeon's office to send them info & they assure me that they will send it out.

 

I receive an E.O.B. from my medical insurance (UHC) stating that the claim they received

did not have the descriptions of service or the correct CPT codes. I called UHC to see what

they needed exactly. They said the CPT codes on the claim were deleted from the system in

2005. She also said that the claim should be on a 1500 claim form, as they couldn't process it

from an office statement. She gave me the correct CPT codes and descriptions.

 

I called the billing dept & gave them the info. Another month goes by & I receive a letter from

UHC. The letter states :

 

At UHC , we understand that you count on us to process your claims properly. We received a

claim for the above patient and notified you (or your provider) requesting information necessary

to process this claim. Unfortunately, we did not receive a response. Therefore, this claim has

been denied. We want to address this claim, but require the requested information. For us to

further review this claim, we ask that you send the information previously, along with a written

request for reconsideration to the address at the top of this letter.

 

Once this information is received we will review your claim within 30 days and notify you in writing

of our decision. We apologize for the inconvenience and are working to simplify our process.

 

This letter from UHC was sent to us, the provider & the billing dept. Nearly 4 weeks later I called

UHC to see if they received the info. The answer .... NO they did not. At this point I want to scream.

This is beyond incompetency. I now realize I'm getting nowhere w/ this billing office. I do not want

to be stuck w/ a bill when I have insurance and when my insurance company has been so

cooperative and willing to pay. You're only as good as what you're given.

 

I called UHC & spoke w/ the claim resolution dept. I told them about all the problems I was having

resolving this. They documented all the information I gave them & gave me a reference # for accessing

this file. I called the billing dept & gave them the info & reference #.

 

Another month goes by & I call UHC and they still do not have the info they requested . They told me

I could file the claim myself (I wish I knew this before). It seems that each person you speak w/ gives

you a different take on each situation. Its only by luck that you reach that someone w/the correct info.

Seeing that I've already done their bookkeeping & legwork I may as well file the claim myself, which

is what I did.

 

I have spoken w/ 14 different people in regards to this bill. I have all the names, the dates when I

spoke w/ them, and the conversation written in my notes. This went on for 8 months. If anything I

have learned a little about this billing process and just how easily things can fall thru the cracks.

 

Finally, I'm on the right track. No more bills, no more phone calls, no more headaches, peace at last.

 

Oh, but wait..... In January I get a letter from FFCC a CA in Ohio. It states that I owe $799.20 to an

oral surgeon on FL. I know this can't be right so I call them. (this was before I knew better & found CB).

I told them that this was wrong and that it was paid. I faxed them a letter w/ all the details from my notes.

I faxed them 13 pages of documentation.

 

I then get a call from them (FFCC) and they tell me that they spoke w/ the creditor and that I owe them

$799.20. So then I call the creditor & they tell me the same thing. O.K. by now I'm fuming. I called the

CA back & told her that this bill was paid & that she & the oral surgeons office needed to get their facts &

bookkeeping straight. The CA starts ranting & raving that I committed fraud by signing a check that

was not mine. I said what the %&@XX* are you talking about. She said you know you have a check

thats not yours & you have committed mail fraud. (now its mail fraud). I just hung up on her.

 

I'm telling my husband about this and he says "Weren't we suppose to be reimbursed for this because

we paid the dentist up front". I said no, that was a reimbursement for the amount we paid up front for

your back surgery. He then tells me he deposited a check from the surgeon. What check ? When ?

Where? Why ? Was it from the insurance co. or the neurosurgeon's office."I don't know" (famous last words).

 

I'm now flipping out, its Friday afternoon & I can't reach the insurance co. On Monday morning I called UHC

& they told me that they sent a check to my husband ( he is the policyholder ) for the claim I filed. I said

I thought that was sent to the oral surgeon. They said because I filed the claim the check was

sent to us. I asked them if they would send me a copy & they said they would. I thanked them & hung up.

 

I now have a copy of the check & the E.O.B.. On the E.O.B. its says that the "patient amount owed" is

$378.00. I paid them $693.00 on the date of service.

 

This has been a huge communication issue all the way around.This collection now sits on my credit report!!!

What can I do to resolve this once and for all ? I know that this isvery long. Its complicated to say the least,

so I needed to give details. I apologize for the length.

 

I need some major help on this one, PLEASE!!! I am grateful, thankful & open to any suggestions, advice,

instruction or guidance given. THANK YOU !!!!!

 

TIA

[Why Chat]

I have a medical collection on my CR from FFCC. This is the only baddie left on my CR.

In May 2006 my son had his 2 wisdom teeth removed (I know...strange, but he only

had 2 that grew in). The oral surgeon's office verified our insurance coverage, gave

me the form to sign that showed our co-pay amount of $693.00. They gave me a

copy of the form signed by the provider & myself. I gave them my credit card & paid

them $693.00.

 

You must pay them up front for your portion before they do anything, so thats what I did.

They billed my dental insurance and it was denied. Well come to find out, its not considered

dental if the teeth are impacted and anesthesia is not covered. This office supposedly called

the dental insurance with the procedure info, because they were sure quick to tell me my

what my co-pay was. ($693.00). The dental insurance paid $65.00 for the consultation @100%.

 

So now that its considered medical, it should be filed thru my medical insurance. This of course

is a different carrier than my dental. I contacted the oral surgeon's office with all the info I

received from the dental & medical insurance. I also questioned their verification of insurance

coverage and was told that someone would get back w/ me.

 

I continue to call because I never received a call back w/ an answer to my question. I call again

& this time I'm told that their billing dept (at another location) handles all their claims. So I

call them & give them the info given to me & they said they would take care of it & bill my

medical insurance.

 

I still keep getting bills for $592.00 & I continue to call them asking why are they sending

the bills to me & not the insurance company. They now tell me that they are waiting for the

oral surgeon's office to send them info & they assure me that they will send it out.

 

I receive an E.O.B. from my medical insurance (UHC) stating that the claim they received

did not have the descriptions of service or the correct CPT codes. I called UHC to see what

they needed exactly. They said the CPT codes on the claim were deleted from the system in

2005. She also said that the claim should be on a 1500 claim form, as they couldn't process it

from an office statement. She gave me the correct CPT codes and descriptions.

 

I called the billing dept & gave them the info. Another month goes by & I receive a letter from

UHC. The letter states :

 

At UHC , we understand that you count on us to process your claims properly. We received a

claim for the above patient and notified you (or your provider) requesting information necessary

to process this claim. Unfortunately, we did not receive a response. Therefore, this claim has

been denied. We want to address this claim, but require the requested information. For us to

further review this claim, we ask that you send the information previously, along with a written

request for reconsideration to the address at the top of this letter.

 

Once this information is received we will review your claim within 30 days and notify you in writing

of our decision. We apologize for the inconvenience and are working to simplify our process.

 

This letter from UHC was sent to us, the provider & the billing dept. Nearly 4 weeks later I called

UHC to see if they received the info. The answer .... NO they did not. At this point I want to scream.

This is beyond incompetency. I now realize I'm getting nowhere w/ this billing office. I do not want

to be stuck w/ a bill when I have insurance and when my insurance company has been so

cooperative and willing to pay. You're only as good as what you're given.

 

I called UHC & spoke w/ the claim resolution dept. I told them about all the problems I was having

resolving this. They documented all the information I gave them & gave me a reference # for accessing

this file. I called the billing dept & gave them the info & reference #.

 

Another month goes by & I call UHC and they still do not have the info they requested . They told me

I could file the claim myself (I wish I knew this before). It seems that each person you speak w/ gives

you a different take on each situation. Its only by luck that you reach that someone w/the correct info.

Seeing that I've already done their bookkeeping & legwork I may as well file the claim myself, which

is what I did.

 

I have spoken w/ 14 different people in regards to this bill. I have all the names, the dates when I

spoke w/ them, and the conversation written in my notes. This went on for 8 months. If anything I

have learned a little about this billing process and just how easily things can fall thru the cracks.

 

Finally, I'm on the right track. No more bills, no more phone calls, no more headaches, peace at last.

 

Oh, but wait..... In January I get a letter from FFCC a CA in Ohio. It states that I owe $799.20 to an

oral surgeon on FL. I know this can't be right so I call them. (this was before I knew better & found CB).

I told them that this was wrong and that it was paid. I faxed them a letter w/ all the details from my notes.

I faxed them 13 pages of documentation.

 

I then get a call from them (FFCC) and they tell me that they spoke w/ the creditor and that I owe them

$799.20. So then I call the creditor & they tell me the same thing. O.K. by now I'm fuming. I called the

CA back & told her that this bill was paid & that she & the oral surgeons office needed to get their facts &

bookkeeping straight. The CA starts ranting & raving that I committed fraud by signing a check that

was not mine. I said what the %&@XX* are you talking about. She said you know you have a check

thats not yours & you have committed mail fraud. (now its mail fraud). I just hung up on her.

 

I'm telling my husband about this and he says "Weren't we suppose to be reimbursed for this because

we paid the dentist up front". I said no, that was a reimbursement for the amount we paid up front for

your back surgery. He then tells me he deposited a check from the surgeon. What check ? When ?

Where? Why ? Was it from the insurance co. or the neurosurgeon's office."I don't know" (famous last words).

 

I'm now flipping out, its Friday afternoon & I can't reach the insurance co. On Monday morning I called UHC

& they told me that they sent a check to my husband ( he is the policyholder ) for the claim I filed. I said

I thought that was sent to the oral surgeon. They said because I filed the claim the check was

sent to us. I asked them if they would send me a copy & they said they would. I thanked them & hung up.

 

I now have a copy of the check & the E.O.B.. On the E.O.B. its says that the "patient amount owed" is

$378.00. I paid them $693.00 on the date of service.

 

This has been a huge communication issue all the way around.This collection now sits on my credit report!!!

What can I do to resolve this once and for all ? I know that this isvery long. Its complicated to say the least,

so I needed to give details. I apologize for the length.

 

I need some major help on this one, PLEASE!!! I am grateful, thankful & open to any suggestions, advice,

instruction or guidance given. THANK YOU !!!!!

 

TIA

You apparently ( your husband) "converted" an insurance check to your own account instead of signing it over to the OC.

 

Send the OC a bank money order for the amount they should have received ( $592.??= I now have a copy of the check & the E.O.B.. On the E.O.B. its says that the "patient amount owed" is

$378.00. I paid them $693.00 on the date of service. -deduct $315. from the amount of the "converted" check) together with the restrictive endorsement and a "modified" HIPAA letter as follows.

 

(Your Name)

(address)

(City,State, zip)

s.s.# (social security #)

HIPAA Compliance Office

( health care provider creditor)

(address)

(date)

Dear Sir/Madam;

 

This letter is in reference to (account #) for services provided to (name of patient) on (date of service).

 

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

 

Enclosed please find my remittance of ($___) for payment in full of this account.

 

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 a violation of HIPAA and State Privacy Act rules .

 

I am requesting you promptly rescind all such account information furnished to (collection agency) and require them to purge their records of all reference to this account, and that you insure that any and all reporting of this account is immediately deleted from my credit reports.

 

This simple procedure to request the deletion of ALL reference to this account from the records of ( collection agency name) and to require them to have this account information deleted in its entirety from my credit reports will resolve this problem completely.

 

Please respond, in writing within 10 days that you are processing this request.

 

 

Sincerely,

 

signature

(Your Name)

Edited September 25, 2008 by Why Chat

[trix]

I think I may have jumped the gun, because I already sent them a pre-hipaa letter.

Do I still continue with the modified hipaa letter. Do I send it CMRR ?

[Why Chat]

I think I may have jumped the gun, because I already sent them a pre-hipaa letter. I hope you sent the "pre-HIPAA" letter to the CRA's and not to the OC or CA!!!

Do I still continue with the modified hipaa letter. Do I send it CMRR ?

The "pre-HIPAA" letter is for the CRA, you need it done anyway to get a deletion AFTER you pay the OC with the modified HIPAA letter. Yes send it CMRR.

[trix]

Yes, I sent it to all 3 CRA's. Thank You Why Chat for your help!!!!!