Is this true or false? Hospital claims they can't lower my bill because health insurance already claimed it.

[batgirl]

I went to the ER for an emergency. Then I got sent a $800 bill.

 

I have health insurance and I used it. I thought it would cover at least part of the cost. Instead, my insurance covered nothing and they applied it to my deductible (which is 2500 per year).

 

I asked the hospital if they could work with me on lowering the bill, and they told me that because my insurance 'claimed' it they couldn't do anything. If I could get my insurance to 'unclaim' it then they could maybe lower it.

 

Of course, my health insurance said no.

 

Now what? Is this just a bunch of crap from the hospital or is it actually true?

 

I haven't paid it and now it has gone to collections. Now what to do? What are my options here? Ideally, I'd like to just pay a smaller lump sum because obviously I can't afford $800.

[Why Chat]

Get a statement from your insurance as to why they didn't cover it. Usually ER visits are covered.

 

If they do not cover it, find out what the reason was and what the normal allowable charges were that they would have paid IF it had been covered.

 

If the $800. was the normal amount they would have allowed, and if you can not appeal their not covering the cost, then the hosp[ital is correct, once a discounted amount is allowed, even if the insurance Co doesn't pay it, then they can't reduce it any further.

[Clydesmom]

I went to the ER for an emergency. Then I got sent a $800 bill.

 

I have health insurance and I used it. I thought it would cover at least part of the cost. Instead, my insurance covered nothing and they applied it to my deductible (which is 2500 per year).

 

I asked the hospital if they could work with me on lowering the bill, and they told me that because my insurance 'claimed' it they couldn't do anything. If I could get my insurance to 'unclaim' it then they could maybe lower it.

 

Of course, my health insurance said no.

 

Now what? Is this just a bunch of crap from the hospital or is it actually true?

 

I haven't paid it and now it has gone to collections. Now what to do? What are my options here? Ideally, I'd like to just pay a smaller lump sum because obviously I can't afford $800.

 

Yes it is actually true and it is illegal for the hospital to discount your portion.

 

They have a contractual obligation to bill you for the amount not covered by insurance and cannot waive it. Not only does it violate the contract and many insurance companies do sue providers who violate this provision in the contract but it also violates federal law on kickbacks and rebating in insurance coverage.

 

The reason this is a provision in insurance contracts is the provider has already negotiated a discounted rate for the services for their members. If you get an additional discount that benefits only you and not the provider.

 

For future reference: do not allow an account to go to collections. Most if not all hospitals will take payments as low as $20 a month to pay off a balance. They are way more willing to work things out than most creditors before it goes to collections.

[batgirl]

I talked to my insurance and ER is not covered at all. Basically I am only covered if I reach my $2500 deductible, which I know I won't.

 

And I am being charged the full price. There is no "deal" with the hospital rates by going through my insurance.

 

Does this mean that having health insurance essentially just screwed me over? The hospital already told me that if my insurance didn't claim it they could reduce it.

 

It is already with collections. I got a letter a couple weeks ago. Now what? Can I settle with a lump sum with the collection agency?

[Clydesmom]

It probably isn't that health insurance processed it, as much as that the account has already gone to collections.

 

You are not screwed by having insurance you have what is known as a high deductible (although $2500 is low compared to some) catastrophic plan. It covers when you need surgery or have acute medical problems by reducing your out of pocket to just the deductible. Given that in a few short months Obamacare will require you to have a policy I would not let it go because costs will soar for new applicants to cover all those without coverage.

[batgirl]

What they said about the discount was before it went to collections. As soon as I got a bill from them I called the hospital asking to lower it and they said they would normally be able to but couldn't because it got applied to my deductible.

 

Then I didn't pay. Because I can't afford it.

 

Now it's with collections.

 

What is my next best plan of action? Settle with collectors or try again with the hospital? Is there a way I can have the hospital re file it with insurance for a lower amount? This way it could still be applied to my deductible but in the correct amount. I had a problem with a different doctor incorrectly filing with my insurance before and he was able to re submit.

[gogogophers]

 

And I am being charged the full price. There is no "deal" with the hospital rates by going through my insurance.

 

 

 

If the bill is only $800, you definitely got some kind price reduction based on whatever your insurance company has negotiated for rates. $800 may seem like a big bill (and it is) but most ER visits that are charged at the straight price are well past $1000 for even the most minor medical issues. If you have an option to change your insurance coverage during an open enrollment period, it might be good to compare the monthly costs for a lower deductible plan.

[mk_378]

The $800 should be the discounted amount based on the insurance contract.

 

Your best option is to talk to the hospital and make payments directly to the hospital as others suggested. Even small amounts will work but don't commit to anything you can't afford. Once you have a payment plan in place and stay with it you should be able to get it recalled from the CA.

 

In the future, offer to pay something, even $50 or $100, on the spot at the ER, and work with the hospital only. Don't ignore it and let it go to collections. Hospitals can't charge interest so you have basically a zero APR option.

Edited May 8, 2013 by mk_378

[batgirl]

The $800 should be the discounted amount based on the insurance contract.

 

Your best option is to talk to the hospital and make payments directly to the hospital as others suggested. Even small amounts will work but don't commit to anything you can't afford. Once you have a payment plan in place and stay with it you should be able to get it recalled from the CA.

 

In the future, offer to pay something, even $50 or $100, on the spot at the ER, and work with the hospital only. Don't ignore it and let it go to collections. Hospitals can't charge interest so you have basically a zero APR option.

 

Yes, I just checked, the discounted amount was $900. So I got $100 off.

 

Is there no way I can just settle this with a smaller lump sum? I have so much other debt and this is my smallest debt and I'd like to just get it dealt with. I have managed to put together some cash to negotiate with credit card companies but some of that cash could be used for this to pay a lump sum.

[clumsycajun]

The $800 should be the discounted amount based on the insurance contract.

 

Your best option is to talk to the hospital and make payments directly to the hospital as others suggested. Even small amounts will work but don't commit to anything you can't afford. Once you have a payment plan in place and stay with it you should be able to get it recalled from the CA.

 

In the future, offer to pay something, even $50 or $100, on the spot at the ER, and work with the hospital only. Don't ignore it and let it go to collections. Hospitals can't charge interest so you have basically a zero APR option.

 

I keep hearing to NOT contact the hospital directly but to send them DV letters. Yes or no?

[mk_378]

I keep hearing to NOT contact the hospital directly but to send them DV letters. Yes or no?

No. Sending a DV letter to an original creditor doesn't do anything. The FDCPA and its DV process is for collection agencies.

[clumsycajun]

 

I keep hearing to NOT contact the hospital directly but to send them DV letters. Yes or no?

No. Sending a DV letter to an original creditor doesn't do anything. The FDCPA and its DV process is for collection agencies.

Thanks for clarifying. I'm kind of on information overload. I should be taking notes here and there instead of saving threads.

[Why Chat]

 

The $800 should be the discounted amount based on the insurance contract.

 

Your best option is to talk to the hospital and make payments directly to the hospital as others suggested. Even small amounts will work but don't commit to anything you can't afford. Once you have a payment plan in place and stay with it you should be able to get it recalled from the CA.

 

In the future, offer to pay something, even $50 or $100, on the spot at the ER, and work with the hospital only. Don't ignore it and let it go to collections. Hospitals can't charge interest so you have basically a zero APR option.

 

Yes, I just checked, the discounted amount was $900. So I got $100 off.

 

Is there no way I can just settle this with a smaller lump sum? I have so much other debt and this is my smallest debt and I'd like to just get it dealt with. I have managed to put together some cash to negotiate with credit card companies but some of that cash could be used for this to pay a lump sum.

Negotiating with credit card companies will do you very little good. They will not take you back, your credit reports will at best show a paid charge off or paid collection, IF you pay the collection agency you will at best get a paid collection. Neither of those will do your credit any good.

 

Pay your current medical bills, get your credit reports, opt out, delete old addresses, send dispute letters on old medical collections.

 

If your credit card debts are over the SOL time period for your State you can get rid of those also once you have finished with the medical ones.

[batgirl]

So what is my next course of action? It is already with collections. Should I contact the hospital first? And do what?

[Why Chat]

Follow all these instructions:

 

http://www.whychat.5u.com/GUIDEBOOK.html

 

Once you have opted out and deleted old addresses, you send each CRA the initial dispute letter in the HIPAA letter guide

 

http://www.whychat.5u.com/GUIDE%20HIPAA%20PROGRAM.html

 

IF, in response to your initial dispute letter, the reporting CA responds back to you with account information that matches your records, you can then pay the hospital with the HIPAA letter insert "a".

 

Otherwise, follow all the other steps in the HIPAA letter program.

 

It is POSSIBLE, depending on the age of these accounts, that they may be deleted from your reports with the initial dispute letters.

 

Come back to this thread for additional instructions once you have the results of your first steps.

[batgirl]

Follow all these instructions:

 

http://www.whychat.5u.com/GUIDEBOOK.html

 

Once you have opted out and deleted old addresses, you send each CRA the initial dispute letter in the HIPAA letter guide

 

http://www.whychat.5u.com/GUIDE%20HIPAA%20PROGRAM.html

 

IF, in response to your initial dispute letter, the reporting CA responds back to you with account information that matches your records, you can then pay the hospital with the HIPAA letter insert "a".

 

Otherwise, follow all the other steps in the HIPAA letter program.

 

It is POSSIBLE, depending on the age of these accounts, that they may be deleted from your reports with the initial dispute letters.

 

Come back to this thread for additional instructions once you have the results of your first steps.

 

For the first link, should I 'opt out' from everything? Or just the credit report opt out?

 

I signed up to receive one of my credit reports (will be mailed in 24 hours, the other one apparently I already used this year and a different one had an error in identifying me). Should I try to get all 3 or is 1 good enough?

 

Signed up to receive MIB as well (will be mailed in 15 days).

 

Should I NOT talk to the hospital and try to sort it out with them first? I figure it couldn't hurt...

Edited May 13, 2013 by batgirl

[Why Chat]

 

Follow all these instructions:

 

http://www.whychat.5u.com/GUIDEBOOK.html

 

Once you have opted out and deleted old addresses, you send each CRA the initial dispute letter in the HIPAA letter guide

 

http://www.whychat.5u.com/GUIDE%20HIPAA%20PROGRAM.html

 

IF, in response to your initial dispute letter, the reporting CA responds back to you with account information that matches your records, you can then pay the hospital with the HIPAA letter insert "a".

 

Otherwise, follow all the other steps in the HIPAA letter program.

 

It is POSSIBLE, depending on the age of these accounts, that they may be deleted from your reports with the initial dispute letters.

 

Come back to this thread for additional instructions once you have the results of your first steps.

 

For the first link, should I 'opt out' from everything? Or just the credit report opt out? just the credit report opt out

 

I signed up to receive one of my credit reports (will be mailed in 24 hours, the other one apparently I already used this year and a different one had an error in identifying me). Should I try to get all 3 or is 1 good enough?

 

Signed up to receive MIB as well (will be mailed in 15 days).

 

Should I NOT talk to the hospital and try to sort it out with them first? I figure it couldn't hurt...

You should get all 3 as you do not know what is reporting unless you do.

 

Do not talk to the hospital, they will relay data to the CA and that is what you do not want.

[DebtDave]

Get a statement from your insurance as to why they didn't cover it. Usually ER visits are covered.

 

If they do not cover it, find out what the reason was and what the normal allowable charges were that they would have paid IF it had been covered.

 

If the $800. was the normal amount they would have allowed, and if you can not appeal their not covering the cost, then the hosp[ital is correct, once a discounted amount is allowed, even if the insurance Co doesn't pay it, then they can't reduce it any further.

 

BUMP

 

So is this pretty much true? If you have an $800 ER bill because it's been "discounted" by your employer health plan, the hospital will not be able to negotiate it?

[Why Chat]

TRUE

[DebtDave]

Will a CA be able to negotiate though?

[Why Chat]

Will a CA be able to negotiate though?

What do you mean by "negotiate"?? If you default on the account and it goes to a CA and winds up on your credit report as a VERY BAD COLLECTION ACCOUNT. And you do not pay the CA the full amount PLUS interest and fees, it is POSSIBLE that after some time the CA will make you an offer to pay it off in installments and the account reporting will be changed ( eventually) to a "paid/settled" collection-- which will be WORSE for your credit than an unpaid one because it is still derogatory but NEWER.

 

If you can pay the OC NOW before it gets turned over to a CAor make arrangements with the OC to pay it off in installments over LESS than 3 Months you MAY be able to avoid getting your credit damaged.

 

If it has already been turned over to a CA( and it is a VERY recent account) then you need to work through the HIPAA letter program to pay the OC and avoid any ding to your credit. ( of course if your name "DebtDave" describes your total circumstances then this is a different ballgame as if your credit is already so bad one more account will likely make little difference if you do not pay )

[DebtDave]

 

Will a CA be able to negotiate though?

What do you mean by "negotiate"?? If you default on the account and it goes to a CA and winds up on your credit report as a VERY BAD COLLECTION ACCOUNT. And you do not pay the CA the full amount PLUS interest and fees, it is POSSIBLE that after some time the CA will make you an offer to pay it off in installments and the account reporting will be changed ( eventually) to a "paid/settled" collection-- which will be WORSE for your credit than an unpaid one because it is still derogatory but NEWER.

 

If you can pay the OC NOW before it gets turned over to a CAor make arrangements with the OC to pay it off in installments over LESS than 3 Months you MAY be able to avoid getting your credit damaged.

 

If it has already been turned over to a CA( and it is a VERY recent account) then you need to work through the HIPAA letter program to pay the OC and avoid any ding to your credit. ( of course if your name "DebtDave" describes your total circumstances then this is a different ballgame as if your credit is already so bad one more account will likely make little difference if you do not pay )

 

 

Yes that is a correct description of my financial life-I'm in the final weeks of a CH7. Literally days after filing spent 30 minutes at a local childrens ER(pediatrian office was 'open' but he didn't show up that Saturday morning per his receptionist) for what turned out to be a nursemaids elbow on Dear Child. An urgent care, in network, turned away as they do not see children and advised us to go local Childrens since it was a Saturday.... Get to hospital. Kid gets joint reset. Pay a $300 copay because that's what is on my card. I am told there may be a bill depending on insurance plan. When I asked well what is the amount, I'm told "I don't know it depends on the insurance" but that the copay goes towards it. WHOTHEHELLDOESNTKNOWTHEIROWNPRICE? In and out in 30 minutes. Bill for a remainder just over $800 received a few weeks later.

 

I'm aware that there is a six month grace period before a medical provider can report and turn over to a CA. I thought I'd wait a couple of months before reaching out to the hospital and asking to negotiate this bill but it sounds like that isn't an option(basically just tell them that they got $300 for 30 minutes the day of and call it square). Received another bill saying that if they don't hear from me in 30 days they have to turn over to collections. Sorry but not sorry, I'm not paying over $1,100 for something that took a minute to do without being told upfront...and this is after spending $6K for the year in healthcare premiums.

Edited March 24, 2017 by DebtDave

[Why Chat]

Get your EOMB showing what was billed, what was ALLOWED, what was paid, and what ( if anything) was left as patient responsibility.A "remainder" may be illegal balance billing.

 

In your case send the health care facility this:

 

(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 $800

This account is a billing error.

It has been paid,( attach receipt for the $300 and copy of your EOMB) .

It is not a valid bill and has been properly disputed, therefore I 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 Omnibus Final Rule effective 09/23/2013 interpreting and implementing various provisions of the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act) as issued 11/30/2009

(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.

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 to (credit reporting bureaus) is 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.In addition the new Omnibus Final Rule states:when patients pay out of pocket in full, they can instruct their provider to refrain from sharing information.This letter serves as that instruction

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)

[Deadbeatloser]

What they said about the discount was before it went to collections. As soon as I got a bill from them I called the hospital asking to lower it and they said they would normally be able to but couldn't because it got applied to my deductible.

I call BS. (On them, not you.)

 

I went to the hospital for a procedure a couple years ago. Some X-rays or something. Billing told me that insurance wouldn't cover it and it would go against the deductible. It was going to be $1200 but.... if I paid right there they would only charge me $900 but report the whole $1200 to the insurance.

 

This was not some dirty doctor working out of a van, this is a huge hospital group with major facilities all over the country.

 

I would keep pushing to get the bill discounted. It's not that they can't, it's that they won't.

[Why Chat]

I think you are talking apples and oranges.

 

You can't use your experiences from years ago to deal with a more current situation where there are newer laws in place.

 

Just follow the instructions and send the HIPAA letter