Help with Dr.'s office horrible billing!

[gary4872]

My wife made 4 trips to a doctor's office. Our copay is $20 per visit. On each visit, they would only charge my wife $15, insisting that is what they had on their file. My wife told them (each time) that our copay should be $20 and they must be mistaken. They would still only charge $15. They also copied her insurance card on each visit and on the card it clearly says the copay is $20. We have never had any other insurance plan when visiting this practice.

 

Fast forward a couple of months. Now they send a bill for $20 ($5 per visit) plus a $20 late fee. They refuse to remove the late fee. I've paid the $20 but refuse to pay the late fee. We also have received a notice from a CA within a week of receiving the $40 bill for the first time. The $20 payment that I made was to the office directly. I haven't responded to the CA yet.

 

How to move forward?

[Why Chat]

My wife made 4 trips to a doctor's office. Our copay is $20 per visit. On each visit, they would only charge my wife $15, insisting that is what they had on their file. My wife told them (each time) that our copay should be $20 and they must be mistaken. They would still only charge $15. They also copied her insurance card on each visit and on the card it clearly says the copay is $20. We have never had any other insurance plan when visiting this practice.

 

Fast forward a couple of months. Now they send a bill for $20 ($5 per visit) plus a $20 late fee. They refuse to remove the late fee. I've paid the $20 but refuse to pay the late fee. We also have received a notice from a CA within a week of receiving the $40 bill for the first time. The $20 payment that I made was to the office directly. I haven't responded to the CA yet.

 

How to move forward?

You need to make sure that this does not hit your credit reports.

 

Opt out ( both you and your wife)

 

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

 

Send this to the Dr. ( I have edited it for your purpose-this is NOT to be used by any other reader)

 

(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 services provided to (name of patient) on (dates of service).

 

In regard to the "late charges" of $20.

 

This claim is in error.

It is a billing error caused by your office staff refusing to accept the proper co-payments on each visit in spite of my insistance that they do so.

My payment of $20. to cover the amounts they refused to accept was transmitted to you xx/xx/xxxx by ( give check #)

It is not a valid charge and I am hereby properly disputing it and your agent's claim and request complete deletion from all your agent (name of CA)'s records and archives.

 

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,and subtitle D of the ARRA ,SEC. 13401. APPLICATION OF SECURITY PROVISIONS AND PENALTIES TO BUSINESS ASSOCIATES OF COVERED ENTITIES;and SEC. 13407(1) BREACH OF SECURITY.—The term ‘‘breach of security’’ means, with respect to unsecured PHR identifiable health information of an individual in a personal health record, acquisition of such information without the authorization of the individual. you may be held liable for the actions of (collection agency name). Please note that the these liabilities are under the penalty rules of the HITECH Act as issued 11/30/2009. .

 

 

The HIPAA Privacy Rules prohibits a covered entity from using or disclosing an individual's protected health information ("PHI") unless specifically authorized by the individual or otherwise allowed under the Privacy Rules.

 

In general, PHI encompasses substantially all "individually identifiable health information" that is transmitted or maintained in any medium. "Individually identifiable health information" includes health information that is created or received by a health care provider, health plan, employer, or health care clearinghouse, and that relates to an individual's physical or mental health or condition, including information related to an individual's care or the PAYMENT for such care.

 

Your furnishing of my account information to (collection agency name), is not in compliance with HIPAA,or (name of your State}'s Privacy Act, and any subsequent reporting of this account on my credit reports 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 when there is no legitimate business purpose.

 

Therefore 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 prohibitted.

 

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

 

I am reserving the right, to take appropriate legal and civil action including reporting to any applicable regulatory authorities any lack of cooperation or compliance with this request.

 

I hereby waive my rights under HIPAA and any State Privacy Act for the single purpose of your transmission of this request and accompanying documentation in any required report you must make to your E &O insurance carrier.

 

Sincerely,

 

signature

(Your Name)

Edited August 20, 2010 by Why Chat

[gary4872]

Thanks Why Chat! Letter sent out yesterday CMRRR. Will keep thread updated.

[gary4872]

So I've received their response and they clearly didn't completely understand it. For example, they state that:

 

Regarding paragraph five you refer to ‘health plan’ and indicate that you believe we cannot give an insurance company PHR. This is incorrect regarding the insurance plan that you have and present to us to bill for you. The agreement you sign with the insurance plan and with us states that we can provide them with your PHR in order to have your claims paid.

 

For some reason they read the paragraph that you provided, which defined generally the term, as referring specifically to information provided to an insurance company

 

Anyhow, more to the point, they state:

 

There has not been any PHR divulged to a collection agency. Therefore, we are in no violation of HIPAA laws.

 

...and further that:

 

Our attorney has stated that we are not in any violation of any laws and that we do have the right to assess a late fee on accounts not paid in full on a timely basis. Therefore, the $20 late charge stands as it is ultimately the responsibility of the patient to pay their account.

 

Obviously this is wrong. That being said, I'm strongly considering to just pay at this point. We will be applying for a car loan in the next few months and I don't want to have to chase this down if it hits my wife's report (yes, she has opted-out). If I were to pay, what is the best way to do this to ensure that it doesn't hit? In the interim we have received another letter from the CA, but we should still be within the initial 30 days to respond.

[gary4872]

Anyone?

[Why Chat]

So I've received their response and they clearly didn't completely understand it. For example, they state that:

 

Regarding paragraph five you refer to ‘health plan’ and indicate that you believe we cannot give an insurance company PHR. This is incorrect regarding the insurance plan that you have and present to us to bill for you. The agreement you sign with the insurance plan and with us states that we can provide them with your PHR in order to have your claims paid.

 

For some reason they read the paragraph that you provided, which defined generally the term, as referring specifically to information provided to an insurance company

 

Anyhow, more to the point, they state:

 

There has not been any PHR divulged to a collection agency. Therefore, we are in no violation of HIPAA laws.

 

...and further that:

 

Our attorney has stated that we are not in any violation of any laws and that we do have the right to assess a late fee on accounts not paid in full on a timely basis. Therefore, the $20 late charge stands as it is ultimately the responsibility of the patient to pay their account.

 

Obviously this is wrong. That being said, I'm strongly considering to just pay at this point. We will be applying for a car loan in the next few months and I don't want to have to chase this down if it hits my wife's report (yes, she has opted-out). If I were to pay, what is the best way to do this to ensure that it doesn't hit? In the interim we have received another letter from the CA, but we should still be within the initial 30 days to respond.

Pay the $20. to the OC with the HIPAA letter insert "a". Follow all the instructions.( money order, endorsement on back "for deposit only",make copy front and back)

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

It may seem like "overkill" for this, but you want to avoid having the account report as a paid collection.

 

Use the following shortened version of the HIPAA letter:

(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 $20.

 

Enclosed please find my remittance of $20. for payment in full of the "late fee" charged to this account.

Please note that I am paying this improper and unwarranted fee, which is NOT a "late fee" but due to bookkeeping errors of your staff as a courtesy to you.

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 .

 

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

 

I am requesting you promptly rescind all 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 to my credit reports is prohibited.

 

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 any possible reporting to my credit reports will resolve this problem completely.

 

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

 

I am reserving the right, to take appropriate legal and civil action including reporting to any applicable regulatory authorities any lack of cooperation or compliance with this request.

 

I hereby waive my rights under HIPAA and any State Privacy Act for the single purpose of your transmission of this request and accompanying documentation in any required report you must make to your E &O insurance carrier.

 

Sincerely,

 

signature

Edited September 9, 2010 by Why Chat