OK...I am posting this question as I am not sure which this actually would fall under and wanted to get the boards opinions and next course action.

I sent validation letter to CA (West) on wife's old medical collection account as it came back several times from CRA as verified/accurate.

West Asset Mgmt sent back letter stating they completed their investigation and debt is valid. Their proof that was sent along with their letter is an actual billing statement from the hospital listing everything from amount of days stayed, date admitted, date released, medications prescribed, other various services and treatments performed.

This seems like it would fall under the PHI rules? Can someone enlighten me in which this should be treated and what our next course of action should be?

i.e - threaten collection agency with HIPAA violations or turn to hospital directly?

Thanks in advance!

I think if they requested that info from the hospital then wouldn't that be validation??? I wouldn't pay them a dime. If you have to pay, pay the hospital and dispute the CA..
But then, I wonder. I'll let someone else chime in..bump

Well...I was more wondering if the hospital provided that type of information to anyone other than us or a doctor, wouldn't that be a violation of the PHI laws??

If they indeed violated them by sending then I would presume the next steps would be to threaten the OC (hospital) in this case with the release of private info and press for full retraction/deletion from CA??

Thoughts????

What state are you in?

Wrong, if there is a business associate agreement in place between the Provider and CA, then PHI for payment purposes may be exchanged.

There is no HIPAA violation as YOU requested the account information in your validation letter.

If it is a legitimate debt owed, you can pay it to the OC health care provider with the HIPAA letter, thereby obtaining a deletion instead of a "paid collection", or if you are past SOL and it is for an amount you either can not pay, or do not believe you should pay you can try the SOL letter to the CA.

Be warned, in SOME cases, if it is a State or County Hospital, there MAY be NO SOL.

Why Chat, thanks for the info. The only reason I thought it might be a violation is due to it showing a lot more than just amount owed, such as meds prescribed, type of treatments, etc?

The debt is legit, insurance was suppose to have covered it and didn't. Debt is 3 yrs old and in Texas so I believe the SOL is 4 years. Not a state or county hospital, private I'm sure so?

You feel the only option to even attempt is SOL letter to CA?

Any other thoughts, please share.

Thanks to everyone who replied!!

Why, exactly, did the insurance not pay it?

It DOES make a difference.......

That one, I have no idea on...just going off of what wife said?

Didn't know her then so...have no way of knowing that. Should she try calling insurance company and see if anyone there has explanation?

sometimes of you get a detailed billing statement DIRECT from the OC it can give insight into why claims were denied. DH has a med debt that shows ins was billed and was denied as "duplicate service or charge". only problem with that is it was the first physical he had with that insurance & provider. we filed an appeal but it was denied becaus ethey only review the inof as submitted. The OC seems to have coded it wrong so it was denied. Other charges were denied and show "info needed from subscriber". The ins had all of DH info so it seems the OC again failed to include necessary info. We hold the OC responsible for these failures and DH has sent a written dispute of the charges ABOVE what ins would have paid based upon identical billings on me. We will not pay things if the failure was due to OC error, we should not have to.

Anyways, the way I requested this info was send a letter to the OC billing dept. Requested dates of service and detailed breakdown of charges. The statements we received even included the amounts submitted to ins for payment.

Yes you SHOULD call the insurance to find out WHY it was denied AND if you're responsible for the bill