Questions and some Answers

[Jarvik]

I had an emergency room visit in August 2008. I had insurance and this hospital is under-contract as in-network.

First notice that the bill was unpaid was a hit on my credit as I have credit watch. No notice or letter from collections was sent.

 

I never received a bill from the hospital either.

 

I immediately called Aetna and discussed this with them. We called the Tenet owned hospital and they wouldn't talk to me nor my insurance agent, and would only transfer us to the CA NCO.

 

Aetna got on the phone with NCO and myself and explained I was insured. Hospital claims I never submitted insurance, but at that time Aetna gave them this info so they could re-submit the claim.

 

They resubmitted, I talked with NCO dispute dept, and asked them to send a request for removal to the CRA's as I was not responsible for this debt and Insurance was. Within 24 hours, it was gone from my credit reports.

 

Aetna denied the claim as it wasn't filed in a timely manner. In my Aetna statement it said "1. You are not responsible for this charge, because the provider did not file the claim within the required time limit.

This is because under the hospital in-network contract they have to file within a certain time for patients that are covered by the contracted insurance company.

 

Now 6 months later I receive a collections letter from Central Financial Control, asking for the contracted amount.(Balance Billing?)

I call Aetna, walk through the history of my previous rounds with NCO.

We call Central Financial Control, AKA Syndicated Office Systems, AKA Tenet Healthcare.

Walk through this once again, I was insured, this hospital is an in-network hospital, they didn't file the claim in a timely manner, so they have to eat the cost.

CFC told myself and the insurance agent that I didn't sumbit my information, and I am liable regardless.

CFC tried to say that I didn't provide any insurance information, within some timeline of their own so they are exempt from their contractual agreements with Aetna, and therefore I am liable.

 

At this point no credit hits just a "your account has been flagged to be sent to CRA's" (they do this every Wednesday fyi)

So Aetna tells them they are going to re-process the claim.

I have Aetna get on the phone and call them the day they sent it, and the day it would arrive. Aetna pays the claim on June 30, by EFT.

 

I called Aetna with my concerns of my co-payment. They paid the Hospital/OC directly, but how do I make my payment to the hospital when I don't have an account or even a bill showing what I owe!

Aetna and get on the phone with the CFC/Tenet, I have to pay the co-pay to the Hospital itself but send it to CFC. The Aetna agent, told them what my co-pay was.

I expressed my concern that I didn't want this to hit my credit as this being flagged to for submission to CRA's.

CFC/Tenet told myself and my Aetna insurance agent that it wouldn't hit my credit and I would have 30 days, before it was sent to the CRA's

That is, 30 days from the day that Aetna processed my claim and sent the payment.

The Aetna agent has this documented in my claim history!

 

 

Aetna paid on June 30th. CFC sent to CRA's and hit my credit July 9th.

Showing original balance owed as the contracted amount between Insurance and Hospital and amount owed as much less than my co-pay.

I told the Aetna agent this and he stated it was balance billing, he also filed a complaint against the hospital in Aetna.

 

 

 

1. Aetna assumed libality for the payment and the hospital directly accepted payment from them.

2. By accepting payment from Aetna it seems CFC/Tenet agrees I was covered and also agrees

2. CFC/Tenet balance billed me the contractual amount. If they wanted to use the argument that I didn't submit insurance to them in a timely manner, and thus I wasn't covered by it, why are they billing me the contracted rate?

3. Since this was already once reported to CRA's , then the first CA(NCO) agreed I wasn't liable as insurance was, wouldn't CFC have that info, if they bought the account?

4. If CFC/Tenet had this information, and knowingly pursued this debt, wouldn't they be breaking the contract with Aetna?

 

 

The CFC/Tenet rep admitted they worked for Tenet.

The CFC/Tenet rep admitted they didn't buy the debt.

The CFC/Tenet rep admitted they were an inhouse billing for Tenet.

The CFC/Tenet rep stated they send their credit sumbissions every Wednesday.

The CFC/Tenet rep stated I had 30 days from the day the notice was drafted to respond.

This notice was for the entire amount, yet on my credit report its 1/3 of the amount.

 

Any thoughts on what I should do now?

[bonbonXO]

Your situation may seem really complicated but don't get frustrated it can be fixed!

I am only going to address how to remove the negative entry off your credit report.

Start Why Chat's HIPAA process

 

OPT OUT:

http://whychat.5u.com/OPTOUTINST.HTML

 

Deleted any old address if you have moved within the last 8 to 10 years

 

Send the CRA's where the account is reporting this: ( follow ALL the directions-even if they seem odd)

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

 

If the collection account is not deleted as a result of the Pre HIPAA dispute with the CRAs (http://whychat.5u.com/hipaadisp.html) then send the OC (hospital) the FORM LETTER TO ORIGINAL HEALTH CARE PROVIDER with insert “b†http://whychat.5u.com/hipltr.html

This account is in error. It was not transmitted in a timely manner to my insurance company. It is not a valid bill and has been properly disputed, therefore I request complete deletion from your agent (name of CA)'s records and archives.

 

Sorry my formatting gets really goofy when I go back and forth from Why Chat's web site sometimes and I can't fix it.

There are additional steps to the process after this.

Edited July 14, 2009 by bonbonXO