Judge rules funding for the CFPB must be restored.

All is not lost YET!!!

We received a collection letter from a debt collector.  The amount is about $325.  Dear Spouse had been ordering some prescription medical equipment from this company.  There were two instances where they shipped the equipment but botched the insurance protocols, so the insurance denied them.   They charged our account at the time of shipment (an HSA debit card, probably the first mistake).  I have statements from the insurance my liability for these is zero.  After unsuccessfully resolving this with the provider, on the last shipment I simply withheld the amount in question.  Phone discussions on this topic lasted about a year, and simply went in circles.  I followed up with a letter including copies of the insurance and bank statements.  The next month's bill credited one but not the other without explanation, then they  sent the balance to the debt collector. So, I intend to dispute the debt and include copies of the insurance statement and bank statement. Is that overkill, given it is a medical debt under $500? The Why Chat method seems to not apply at this point yet. Thanks.

Several months later, I unexpectedly received a final notice from a physician group. This was actually the first bill I had received from them, even though I had been in regular communication with their office. It turns out they only send electronic statements for physicians bills—not paper. Because of the volume of medical appointments I was managing at the time, I had previously opted out of all electronic communications so I never received those.

Despite the confusion, I continued to set up and follow new payment arrangements. One of those was for a $700 balance, which I was paying at $50 per month. I never received any monthly statements or reminders. Last month, I went to log in and make my next payment—but the account was no longer found. I called their office and was told that I had been five days late, and the remaining $140 balance had already been sent to a collection agency. I explained the situation and asked for it to be pulled back, but they refused.

While I understand this may not negatively affect my credit, it's the principle that bothers me—especially after doing everything I could to communicate and stay on top of payments under extremely difficult circumstances.

Now I’m not sure which WhyChat letter (if any) applies to this situation, since it’s a medical debt that I was actively paying and only went to collections due to a very minor delay and the fact that they were not sending statements. I’d really appreciate any guidance on what to do next.

Last week I got a weird call from a CA and I knew what it was right away so I went back to the site for the medical group and was able to pay this amount differently than what I tried before. It said that I didn’t owe anything but I paid anyway hoping it would stop the process but I knew they had already sold the debt..

Today I got a letter from the CA and as of today the CA is not on my credit. Wondering what I should do here, do I send a debt validation and then tell the OC that I’ve already paid? 
 

Thank you so much for any help!!

I'm having a weird issue.  I subscribe to MyFico and get the quarterly credit reports from them.  Just last week I received an alert that my credit score had dropped about 95 points.  Upon looking into it, I have the following tradeline reporting ONLY via Equifax:

• Account Number: XXXXXXXXXXXXXXXXXXX1111 (only last 4 given)
• Original Lender: Blank
• Agency Name: 613YC00000
• Date Assigned 10/2022
• Original Balance: $(amount)
• Current Balance: $(amount)
• Responsibility: Individual
• Status: Unpaid
• Comments: Medical

Upon seeing this, I immediately went to annualcreditreports.com, pulled my reports but didn't see any collections accounts.  Additionally, I called Equifax to inquire if this could possibly be because of a "split file"....but after looking into it, they said that is not the case.

Needless to say, MyFico just said to contact Equifax as they only get information from the CRA's.  

Not quite sure where to go from here.  I've been looking through my bills and receipts trying to figure out what this charge is, but I cannot find anything that correlates to it.  Any advice on where to go from here?  Thank you!

I've sent a DV letter, they immediately sent me a summary of services (which likely also violates HIPAA regulations). I am planning to send a second DV letter, with the addresses of Arizona Attorney general, Arizona Financial Regulators, BBB, CFPB,, and a request for $1,000.

Any other suggestions for the next DV, to make it is strong and effective as possible? Scores are all above 820, so the last thing I want is to risk anything at this time. Nothing on my credit reports.

Below you'll find:

-stopping problems before they start

-how to CYA and build a papertrail, since you just can't get around calling

-Prompt Payment Laws

-Common Insurance/Doctor's office scams (or, whose fault is this, the insurer, or the doctor???)

-when they just won't cooperate...

Stopping Problems Before They Start

I'd say a solid 99% of problems people have with insurance companies are simple misunderstandings of what is and is not legitimately covered, and at what levels benefits should be paid. The time to ask questions about coverage, authorization procedures, etc. is BEFORE you see the specialist, and BEFORE you have expensive tests, surgeries, and procedures performed.

Your insurance is a contract between you and your insurance carrier. Your doctor's office staff will hopefully prove helpful and competent in navigating the pre-approval/authorization process, but it is ultimately YOUR responsibility to understand what your particular carrier requires (and believe me, they can get particular) and make sure your physician and his/her office staff jump through any "necessary" hoops. The corrollary to this is, that if your insurance doesn't pay, delays payment, or makes a retroactive denial, you're still responsible to remit timely payment to your doctor. It's not their problem that your insurance company is being difficult, you still agreed to pay for the services rendered. Hopefully though, the doctor's office can prove to be one of your most valuable assets in dealing with the insurance company, so be polite, and keep them informed. The physician's office/hospital is much more likely to be helpful, understanding, and amenable to temporary payment arrangements if you are proactive and explain the problem and solicit help before you've gotten three "pay now or else" letters.

The best way to avoid problems with your insurance company, is to read and understand your member agreement/explanation of benefits. Member agreements are long and tedious. Ours is 400 pages. But, it goes into excrutiating detail on what is and is not covered, what might be covered under certain circumstance (read: you make a real pest of yourself), and your level of coverage for different types of doctor's visits, hospital stays, etc. You'll also want to be very familiar with your maximum out of pocket limit for the year.

Insurance companies make errors in benefits checks all the time (ie, pay 80% instead of 90%). You'll want to be able to spot those errors quickly, and reference the exact part of your member agreement that proves your case.

Insurance companies commonly do "first round denials" all the time for covered benefits, just to see if you're willing to put up a fight. Again, you'll want to be able to reference the exact part of your member agreement that indentifies their error.

So read your member agreement, know it, and understand it. Better now than later. Trust me.

Building a Papertrail, and Covering your Toushie

When dealing with health insurance companies, your papertrail is every bit as important as it is with your credit disputes. The problem is, with health insurance companies you really can't get around calling. I can't tell you how many times I've called to get a confirmation of coverage, or interpretation of coverage. When these promises turned out to be incorrect, I would call back to find that "there's no record of there ever having been a Ms. "x" at ext xxxx." So, here's the process I've adopted to solve that problem:

1) Record the phone call if you can. If you can't, take copious notes on the conversation, or write a reasonable summary of the conversation RIGHT AFTER you hang up.

2) Immediately upon getting through to customer service, ask for the rep's name and ext#. That freaks them out.

3) Don't assume anything. Confirm everything, three times. If you get ambiguous statements, ask for clarifications. I use this statement, "I understand you to say _______. Is that correct?" If they won't commit to anything, or keep talking in circles, make a huge note of that in your summary. Also, write down EVERY version of what you were told. It's not at all unusual for them to answer the same question three DIFFERENT ways. If you get a different answer every time you ask the same question, you want to have notes of this. Also, if you receive authorization for a procedure, demand an authorization number. If they absolutely refuse to provide this, make a note of this.

4) After you get off the phone, write a letter to your insurance company, to be mailed CMRRR. Give the name and ext# of who you talked to, and a summary of the conversation. Explain that the insurance company has 5 days from the confirmed receipt of your letter to clarify or make changes their interpretation of your member contract. If you received an ambigious answer from the CSR on the phone, they have 5 days to clarify. If "the powers that be" believe a mistake has been made, they have 5 days to contact you and inform you of the error. Explain that if you do not hear from them, you will accept that as their agreement that the statements made in your letter are correct. Remember, you HAVE to do the CMRRR. Nothing else will do in this situation.

Written notes aren't the only thing you need to save in relation to your insurance. You need to save EVERYTHING medical that you receive, right down to the envelops. It goes without saying that you need to save every explanation of benefits from the insurance company, along with approval/denial letters. However, you also need to keep all receipts you receive from the doctor's office. Believe me, if it ever goes into dispute whether you paid your co-pay, or even had an appointment on a day the health insurance company believes is a fraudulent claim, you need to be able to prove your case. It doesn't have to be a big, fancy filing system. Infact, we just have a drawer where everything medical goes. That way, if we need it, we've got it.

Prompt Payment Laws

In some states, there are laws governing how quickly your insurer must remit payment for claims received. I'm too lazy to look up and list all the states myself, but I think there's 17 (or something like that) that have these laws. The laws vary slightly from state to state, but basically, the insurer has 30(+5 for mailing) days once they are in receipt of a "clean" (readL properly filed) claim to "act" on it, either by remitting payment, or providing a "good faith reason for denial". For claims purposes, the insurer is considered to have received the claim 5 days from the postmark, triggering the 30+5 day period.

"Good faith reason for denial" means exactly what you'd think. Either the claim has to be found to be fraudulent, or the patient inelligible for benefits at the time services were rendered, or the benefits must be explicitly not covered in the member contract. If claims are frivolously denied (ie, denial for benefits that are unquestionably covered) as is often done to test the resolve of the member, the insurer is not only guilty of breach of contract, but violation of Prompt Payment Laws as well.

Common "good faith reasons for denial" include: verification of insurer liability (a form you fill out certifying that you are who you say you are, and listing any other health insurance you may have), requests for more information, or an improperly submitted claim. Now, some of these are often stall tactics, but they are legal stall tactics. Upon receipt of the necessary documentation, or fulfillment of whatever they (reasonably and legally) asked of you, they have 30 days to remit payment.

If you continue to have problems with delayed claims, and/or you believe the insurer is frivolously denying your claims, you'll need to escalate your efforts.

Common Insurer and Provider Scams

It's no secret that the health industry is rampant with scams. Infact, I marvel everyday at the stories I hear from CBers about their health care billing experiences. Here's what they'll try to do to pull the wool over your eyes:

Doctor's offices

Doctor's offices will commonly send you to collections before your insurance company has had a reasonable amount of time to pay, balance bill (bill you for the portion of the bill your insurer didn't pay), or just plain not file insurance claims properly, and then come after you when the insurance company doesn't pay.

While insurance is a contract between the consumer and the insurer, there is also a contract in place between the doctor and the insurer IF YOU ARE SEEING AN IN-NETWORK PHYSICIAN!!! The doctors have agreed to contracted rates. They have agreed that if they don't file claims properly, or if they fail to receive proper authorization from the insurer, then they get nothing. That's what they agreed to in becoming "participating" physicians.

So quite often, when your doctor's office comes after you because your insurer hasn't paid part of the bill, or the insurer has refused the claim, it's between the doctor and the insurer. It has nothing to do. In my experience, if you are on top of things and call the insurance company and explain what has happened, they'll be more than delighted to call the doctor's office and read the riot act for you. This is where it gets really important to have an excellent paper trail. The insurer is required to mail you an "explanation of benefits" for any claims they receive, explaining what is and isn't covered, and why. If you've gotta piece of paper saying the doctor's office filed a claim wrong, and is entitled to nothing, and a bill from the doctor for what the insurer denied, it's pretty obvious what's going on.

Insurers keep track of how often their providers run scams like this, and will take care of reporting them to the appropriate authorities for you. If the physician continues billing you after the insurer has called and "handled" it, that looks bad too. If a doctor displays a pattern of this sort of unethical billing behavior, they will be dropped from the network and fined by the insurer. The only way the insurer will ever know there's a problem, however, is if you tell them.

So, if you believe you're being fraudulently billed by a doctor, don't even call their office to straighten it out. Call the insurer and save yourself a few phone calls and a lot of irratation.

Insurance Companies

We all know what the insurance companies like to do...deny claims they should unquestionably pay, and stall payment as long as humanly possible. They also really like to tell you one thing on the phone, and then conviniently forget when it comes time to pay as promised.

The single biggest issue, however, is telling you it's a physician's problem and telling you to handle it with them when you're dealing with an in-network provider. If you see an in-network provider, and encounter a billing/collections issue, then it IS UNQUESTIONABLY the insurer's responsibility to handle. You went to see a participating provider precisely to avoid these types of games. If insurance company won't handle the problem with the doctor/hospital themselves, then tell them you don't care whose fault it is, you're just going to start suing people, and will let them figure out who dropped the ball in discovery. Or report them to the Insurance Commissioner...

Then follow through.

When they just won't cooperate...

Sometimes, no matter what you try, the terrorists just won't cooperate. Here's what I recommend:

Contact your State's Department of Insurance/Insurance Commissioner!!!!!!!

They may brush you off, tell you 50 different stories about how something should be covered, or tell you that your dispute with the billing of an in-network provider is between you and them. Spin their wheels for awhile and then tell them that you're giving them one final opportunity to do what is mandated by law before you contact the insurance commissioner. This is where you'll really want to have them on tape; they'll go ABSOLUTELY NUTS!!!

They'll tell you that it's unnecessary, that this is between you and them, and that you're wasting your time. Well, it takes about 15 minutes to file a complaint with the DOI. You probably spent twice that long on hold.

They man give you the run around, but you'll find the dance they do for the insurance commissioner absolutely incredible! If the DOI says "Jump!", the insurance company will ask when they can come down. In my experience, it takes about 2 weeks for complaints to be handled, from the time I raise the flag on the mailbox, until I get the results. It's definitely an expiditious process in my experience.

Remember, the insurance company hates nothing like getting complaints to the DOI.

Other things you can try, include going through your company's HR person, or insurance broker (if you purchased privately). Remember, when you have problems, it's their job to resolve them. Also, a company's HR person will usually have a contact that can handle the problem for you immediately. You should also be familiar with your state's employment laws; if you are paying all or part of the premium for health insurance for your employer, they can be held secondarily liable for the actions of the insurance company they effectively forced you to buy from.

--------------------------------

This is by no means to be considered legal advice, or an exhaustive resource. Insurance laws vary widely by state. These statements are general in nature. While I'm extremely familiar with the insurance laws in North Carolina, I frankly couldn't care much less about what the laws are in other states, and don't have time to research everything right now. Perhaps some of us could get together, and each compile a list of the laws for our state...

I'm sure I've left stuff out, and that you'll have questions. Ask away, and I will do my very best to help you out![/size]

My DH has 6 accounts with one CA/hospital and another 6 from a different CA/hospital. Do I need to send these separately per each CRA or all in one envelope? I know each CRA gets there own dispute, but can mutiple CA go together? I also read that even though I have tried a traditional dispute with a verified response, I can still use the Why Chat method, correct?

I have completed opt outs and address removals up to this point!

Thank you!

@Why Chat

To me, this is classic balance billing, seems patently unfair, and should be disallowed by the "no surprises" act (https://www.cms.gov/medical-bill-rights), so I disputed it with the hospital. I quoted the requirements of the act (good faith estimates, required consent for any charges), and tried to work it out with the provider. They wouldn't budge (though they admitted fault), so I filed a federal complaint against them.

Now, they have moved this account to collections, and I got my initial letter from the CA. I'm considering disputing it as a normal collection, but I also wonder if there are any special circumstances because this is an unresolved dispute with the original provider about their billing practices. I don't want to pay them; it's a matter of principle.

3. Insurer also noted provider did send some bills from the same hospital stay to the correct address, and did get paid on those bills, just not this one.  Insurer could see all of the bills that had been submitted to incorrect address and denied, and none received at correct address. 
4. Insurer informed provider that the window for submitting claims on that bill had since passed.  ie, provider was informed they were never going to get paid.

Provider then promised to remove collection from my pops credit report and get back to him.  Obviously, nothing ever happened.

I recently took this up again.  I have had at least two other recent contacts with the provider's billing department, where I was told the same thing, they would fix it, and nothing ever happened.  

Well, one thing did happen I should definitely make note of.  My pops very recently received a new bill from provider, for same services provided in 2021, where the last line item says the provider resubmitted the bill again to the insurer last month and the insurer denied the claim for the stated reason of that particular service was not a covered service.

This led to another 3 way call with insurer and medical provider, where I luckily managed to get a very experienced and  informed supervisor from insurer who just happened to be taking calls that day, and that guy really let the provider have it.  First he noted there has been no claim activity on this bill in 2 years, and they have never denied any claims for the reason stated on the new bill.   He also noted the provider would have received statements (explanation of benefits) along with the denial letters that clearly indicated the patient had zero responsibility for the bill.  Like, in bed bold red letters!  He made it abundantly clear on that call as well, that particular service was a zero cost service to the patient, under all circumstances.  It wouldn't matter, where, when, how or who, the patient was not to be billed for that service.  period.    He questioned why the provider would have ever billed my pops for anything for that service. He also questioned the professionalism of the provider's representatives, scolding the rep and the provider's company for not knowing these things.

Provider once again promised to remove from credit report, and insurer was quick to note they do record all calls.  That was awesome!  

When provider hung up, I stayed on with insurer.  We talked for a bit.  very helpful.  I asked if the bill the provider most recently sent my pops could be considered medicare fraud.  He said absolutely.  He is sending me the statements and explanation of benefits the provider would have received.

So anyway, I waited over a week, still on credit report.  Now I contact the collection agency, and this is where things really went south.  The collection agency informed me they have had no contact from provider on this acct for almost 2 years.  In other words, provider has made no requests whatsoever to have the collection removed.  I should also note, the collection was disputed long ago, I think via Credit Karma, and was verified.  After trying to explain the activities to date to the initial collection agency agent, I was getting nowhere, just more runaround and so I asked to have this escalated to someone higher up.  She was trying to push it back to provider, and I was having none of it.  As I was explaining the details to the higher up, the collection agency stooge suddenly cut me off, then got really mouthy and insulting and hostile.  So much so that I just hung up.

That really made me angry.  This whole thing has made me pretty angry.  That's when I remembered, there are penalties for this kind of thing.  Normally, I'd be happy to just get this resolved, and move on.  But the stooge from the collection agency changed that.  Now I feel like I need to make an example of both sides of this disaster.  I feel like I could be holding a document that effectively represents Medicare fraud in the latest bill from provider.  I also feel like collection agency has some responsibility in this as well.  But that's why I am here.  This is where the answers are.

What do I do fellers? I know I can get it removed from my pops credit report easy enough, but can I make it sting for provider and collection agency in the process?

I have one collection on my current Equifax and Transunion reports.  It is not on my current Experian report.  It is a medical collection in the amount of $1,090 for services on December 5, 2021.  I am following Why Chat's HIPAA dispute method.  I opted-out on March 24, 2024.  My dispute letters to the CRAs were sent via priority mail, signature required, and they were signed for on April 2, 2024 and April 3, 2024 by Equifax and Transunion. 

I have not received anything from Transunion yet, but today, April 14, 2024, I received a letter from Equifax in the mail.  The letter is dated April 6, 2024 and it states that "We have received your request concerning inaccurate information on your Equifax credit file.  We were unable to locate a credit file in our database with the identification information you provided.  In order to further assist you, we will need additional documents to verify your identification.  Please provide Name, Current and Former Addresses, Social Security Number and Date of Birth.  We ask that you please send us a copy of two different items - one from each of the two categories listed below.  One item will verify your identity and the other will verify your current address.  

The letter goes on to describe the forms needed to process my request.  The two documents required must come from the following:  copy of social security card, W-2 with complete SSN, pay stub with complete SSN, driver's license, utility bill, or a copy of a rental agreement or house deed.  The copies are to be sent to Equifax Information Services LLC, P.O. Box 105069, Atlanta, GA  30348-5069.

Should I send in these documents to Equifax?  This seems like a stall tactic used by Equifax to receive an additional 15 days to complete its investigation.  Thanks in advance for your help.  

The dentist billing office through a series of screwups didn’t properly submit the claim to my insurance as secondary insurance within the time period allowed by the insurance company.  The billing department kept submitting my information to my wife’s insurance instead of my daughters information to my insurance 
 

I have tried for months after the procedure to get it straightened out and have emails I sent to the dentist office and a voicemail from them stating they will take it out of internal collections and submit properly to the insurance. They stated this could take 6-18 months in the voicemail from around sometime in 2021. 
 

today I received a collection notice from TEK Collect out of OH.

i am not trying to beat the system but i have done everything i could to assist in getting them paid . However i don’t feel i should pay the entire amount when a large portion would have been covered by insurance.

i would appreciate any help 

isnt this skirting the law  is it even legal to combine 3 different bills from 3 different times like 2 years apart from 1st bill to 3rd billr

if it is illegal what do i do?

I sent Experian initial letter.

Collection agency responded verifying the debt. Included with the verification is some medical record of the ER visit, including a note that I was notified the provider was out of network and consented to treatment (I do not remember this at all. I was in the ER treated by multiple people and only this provider's bill is an issue.)

My Explanation of Benefits shows insurance paid this provider around $600 and my portion is the standard 20% co-insurance.

When I spoke to my insurance about the balance billing they said it was not balance billing. They said out of network providers can bill me for amounts over the in network rate. They said exception for treatment in the ER does not apply because the insurance is self funded through the employer (and managed by UHC). 

I am concerned that sending the original creditor the letter with option b that this bill is in correct along with the EOB will put me on their radar to sue. Obviously I'd rather the debt sit on my credit report for 3 years than be sued. But is this a rational fear or should I still try to remove it?

My husband has a medical collection for $1900. This was for an E/R visit, prior to having insurance. It went to collections because I wasn't able to negotiate on his behalf due to hospital not uploading the HIPAA form with my name on it while he was out of the country.

He is a lawful permanent resident (Greencard holder) now. He has a SS and is working to build credit.

This collection item doesn't show up on his credit reports yet. We want to pay it, however don't want it to affect his credit.

What is the best way to handle this with the Collection agency (Revco Solutions)?

she received a bill from Medical Revenue Services for a little over $8,000 collecting on behalf of the hospital. The letter states she has until December 15th to dispute the bill. 
 

After doing some research from WhyChats guides, it seems to be appropriate to send the initial HIPAA dispute letter, correct? She eventually wants to settle, but I told her it may be too soon to try, given that she just received the first letter and nothing it reported on her credit report yet. 
 

Unfortunately I want aware of the full circumstances, or I would have had her set up a payment plan with the hospital. 
 

so now, I’m looking for the best course of action. I plan to start her with the HIPAA dispute letter and follow the steps from there. 
 

Am I going about this in the correct way, now that the debit has been sent to a collection agency? 

I reside in Utah and a collection agency (MLC) is trying to collect a total of about $2200 from me that comes from 4 accounts they say I have with Revere Health.

Previously in 2016 they sued me for a bill I owed with that same healthcare office, but that was a much larger amount and at the time they did not want to agree to a $100 a month payment plan. They said the minimum acceptable amount they'll accept was $250. When I provided my response to their serving me, they called me and agreed to $40 a month which was what I could reasonably afford at the time. 

I just finished my payment plan last month and they are ringing me for more debt I owe. This time for about $2200. They told me they will not do a $40 payment plan like before because it'll be too long for their client. They said minimum is $200. I explained I can only do $40 cause that's what my spouse agreed to help me with (we have been separated since 2019) I'm unemployed and a stay at home mom residing with family that help me out. She then said since my spouse and I are still legally married they'll just sue him. I told her I have no problem paying I can call each month and pay $40 but I can't do any more than that. She said it'd only be considered a Voluntary payment and that they can still sue if I'm making payments. Only way to avoid it is to enter into this payment contract of $200 a month but I just can't do that.

I asked for a validation letter and they only sent me the date it went to MLC for collections and that they did not buy the debt, Revere Health is still the original creditor.

The image posted is just one of the 4 letters I recieved and is the oldest account. I made a $40 payment to take care of the small one that was $18 and they allocated the rest to this old one. If someone could help me I'd greatly appreciate it and just let me know what are my options are here if any.

Thank you. 

Example: you call hospital billing and make a payment. They do not tell you you are paying the collection department. They apply said payment as collection.  Collection is TLRA. A company that does account recovery.

It is yet unclear if they are an actual collection agency. Just got a letter from said department today with an unknown payment history. TLra can be easily looked up on the internet for Christus Good Shepherd hospital. It says they are an unincorporated organization owned by Christis Health. Christus is non for profit. Supposedly.

I have never knowingly made a payment to this company.

Background Details / Additional Info

1. This was an emergency
2. Location: California
3. I reached my out-of-network out-of-pocket max and out-of-network deductible by the time this was billed
4. I have the EOB from my insurance for this bill
   1. There is a note on the bottom of my EOB which says:
      1. "HEALTH CARE PROFESSIONAL: THE PATIENT SHOULD NOT BE LIABLE IF YOU ACCEPT THE ALLOWABLE AMOUNT. CUSTOMER: CALL XXXXX AT THE NUMBER ON YOUR XXXXX ID CARD IF YOUR HEALTH CARE PROFESSIONAL BILLS YOU MORE THAN THE "WHAT I OWE" AMOUNT ON THE FRONT OF THIS EXPLANATION OF BENEFITS."
      2. Is this binding in any way?

Timeline

Mid-Late 2021

1. I was taken to the hospital/ER via ground ambulance (out-of-network) after a 911 call
2. After some time, I received a bill at some point for ~$2,000 (I can't remember when or how I got in touch with them for billing)
3. I sent the invoice to my insurance who made a partial payment; their was eventually a correction from the payments by my insurance to the ambulance service which resulted in my insurance paying an additional amount totaling 50% (treating them as if they were in-network and pay the "allowed amount")

May 2023

1. I received the first collections letter from Grant Mercantile Agency stating I have 30 days to dispute

May 30th, 2023

1. I called my insurance and mentioned that I have this collections item for this service which they had already paid and the insurance rep said don't pay them a dime, we'll call them and take care of it. I was amazed and confident it would get resolved, so I didn't send any type of dispute. Eventually the 30 days elapsed and I didn't hear from them, so....

First Week of July, 2023

1. I received a second letter from the collection agency. They said they want a letter of intent to pay or a payment plan setup. They can report this to the credit agency at any time.

July 8th, 2023

1. I called my insurance and made sure to speak with a supervisor. I followed up to find out the resolution, they said the ambulance service would not negotiate and that I had to pay the balance and they marked my claim/despite with their insurance company as "Resolved". It would remain in collections. She said that she would open one more dispute internally to see what more could be done. She said it would be 2-3 day and I'd be notified. I have not gotten an update yet.

July 14th, 2028

1. I spoke to my insurance again and they said that the negotiation that I opened with the supervisor is still on-going.

Where should I start? 

My ex husband took our son to the Emergency Room and our son had to have surgery without my knowledge.  My son did not have health insurance since were were in the middle of our divorce.  I found out after the fact in 1/2021. My ex husband had signed the consent for surgery and financial responsibility since he brought him to the surgery.    I found out from the non for profit hospital that he has listed me as the account holder.  The hospital sent me a bill for $19,736.16.  I then called the hospital legal department and they verified that it was father's bill.  They did not send me proof of this but I have the proof that he is responsible.  Per hospital rules, the parent that brings him in is responsible.  We live in Florida.

The hospital sold the debt to CF Medical LLC charge off on 4/2023.  I received a letter from MBA Law offices on May 31, 2023.  I did not see the letter until now and the due date to dispute is 07/15/2023.  Is this too late to correct and dispute? What can I do?  I can't sleep and very scared.  I can't afford this.  My ex husband drives a Lamborghini and makes over $2million a year refuses to fix this basically wants me to suffer.  

I have been getting calls and VM from MBA law offices demanding payment. It's been reported to the CB.   I am scared. 

This is my ex-husband's debt not mine, .  Any help will be greatly appreciated. Thank you in advance from 1 hardworking single parent, any help greatly appreciated.

Should I write.

"This account is a billing error. (Documentation from insurance attached)."

And then just include the EOB? Thank you for your help.

(insert b)

This account is a billing error.

(1)

It has been paid,( proof of payment attached) .

(2)

It was not properly transmitted in a timely manner to my insurance company.( Documentation from insurance attached)

(3)

It was submitted to, or should have been submitted to ( name of State) for indigent care.( Statute # if available)

LOOK UP YOUR STATE

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.

Before the surgery, the doctor's office took my insurance information and let me know the insurance would pay 75% and the remaining 25% I was to pay the day before the surgery. I paid the 25% but afterward, the insurance didn't pay anywhere near 75%. So the doctor's office wants me to pay the remaining amount even though they have admitted that my insurance company has a history of never paying 75%. My thinking is this is a classic 'bait and switch' due to the doctor's office admitting that they knew my insurance wouldn't pay the amount before I ever stepped foot in their office. I think this is considered fraud.

What should I do? They will turn it over to CA if I don't pay by 01/15/09.

I'm looking for a law firm to extract some damages from APP of Tennessee ED PLLC.  They billed my insurance for $687 for the ER Doc (really a PA) to remove foreign object from my eyeball in November 2021.  My insurance paid them in January 2022 and I have the Explanation of Benefits to prove it.  Then APP started billing me after Health Alliance denied their second attempt to collect on that November 2021 ER visit.  Their people claim that the Health Alliance payment of 687 was to the ER, and not the doc (separate billing).  Well, Health Alliance did pay the ER something like $1300 for the ER visit in November of this year.  (Not sure why the delay for the ER to bill Health Alliance but not my circus, not my monkeys.)

Multiple phone calls to APP of Tennessee with each bill (which they send monthly)...  everytime once I explain it the call taker goes from wanting me to pay (or should I say INSISTING I PAY) to "oh, I see you did send in that EOB.  This should all be taken care of."

Two letters to them as well, with copies of the EOB, etc.

Now it's gone to Wakefield & Associates collection agency.

Like I said, I'm looking for recommendations on a law firm that can file suit for derogatory filings against my credit score, which is in the low 800s, depending on which of the big three agencies pulls it.  I want a firm that will swing for the proverbial fences as they've been repeatedly informed, in writing with proof, that the billing has already been paid, yet they want me to pay again.

I figure some of you have some institutional knowledge on who can get damages for wrongful billing that goes to collections and is reported on one's credit file.

I'm pretty stubborn on this.

THanks in advance.

John in Illinois

I.C. System, INC is the collection agency 

$180

2 years old

Never had a medical collection before. How can we remove this?

I. Introduction

An entity code is a unique identifier that helps healthcare providers and facilities to be identified in medical billing. It is an essential code that helps to ensure that the right provider or facility is credited for services rendered. Entity codes are used in various medical billing processes, including claims submissions, reimbursement, and identification.

II. Types of Entity Codes

There are three types of entity codes: Type 1, Type 2, and Type 3.

A. Type 1 Entity Codes

Type 1 entity codes are used to identify healthcare providers, including doctors, physicians, and other healthcare professionals. These codes are assigned by the National Provider Identifier (NPI) Enumerator.

B. Type 2 Entity Codes

Type 2 entity codes are used to identify healthcare facilities, including hospitals, clinics, and nursing homes. These codes are assigned by the Centers for Medicare and Medicaid Services (CMS).

C. Type 3 Entity Codes

Type 3 entity codes are used to identify healthcare payers, including insurance companies and government programs such as Medicare and Medicaid. These codes are assigned by the Health Insurance Portability and Accountability Act (HIPAA) standard.

III. How Entity Codes are Used in Medical Billing

Entity codes are used in several medical billing processes, including:

A. Billing for Services

Entity codes are used to identify the provider or facility that performed the service. This helps to ensure that the correct provider or facility is credited for the services rendered. It also helps to prevent fraud and errors in billing.

B. Identifying Providers and Facilities

Entity codes are used to identify healthcare providers and facilities in medical records and insurance claims. This helps to ensure that the correct information is entered into the system and that the correct provider or facility is credited for services rendered.

C. Medicare and Medicaid Claims

Entity codes are required for Medicare and Medicaid claims. These codes help to ensure that the correct provider or facility is credited for services rendered, and that the appropriate payment is made.

IV. Entity Code Format

Entity codes have a specific format and length. They are typically 10-digit numbers, with the first two digits representing the entity type. For example, Type 1 entity codes start with the number 1, Type 2 entity codes start with the number 2, and Type 3 entity codes start with the number 3.

V. Entity Code Regulations

There are several regulations related to entity codes in medical billing, including:

A. HIPAA Requirements

HIPAA requires healthcare providers, facilities, and payers to use entity codes in medical transactions. This helps to ensure that the correct provider or facility is credited for services rendered, and that patient information is protected.

B. CMS Guidelines

The CMS provides guidelines for the use of entity codes in medical billing. These guidelines help to ensure that entity codes are used correctly and consistently across the healthcare industry.

C. Other Regulatory Bodies

Other regulatory bodies, such as state governments and private insurance companies, may also have regulations related to entity codes in medical billing.

Conclusion

In conclusion, entity codes are an important part of. They help to ensure that the correct provider or facility is credited for services rendered, and that patient information is protected. There are three types of entity codes, each used for different purposes. Entity codes have a specific format and length, and there are regulations related to their

Received an email from medical services (therapy) stating that my provider declined payment because they weren't my primary on April 6. In short, Kaiser declined because it showed Blue Shield was my primary (because it was in my name, whereas Kaiser is in my husband's name). I wasn't aware of this because the therapy folks didn't send me anything about declined claims. They gave me 7 days to provide information or they were going to bill me $508.00

After researching things, I only needed to provide my policy info for Blue Shield (which they accept) so that they can bill them for the 4 sessions. They're within the duration of coverage. They would then bill to my primary (Kaiser). I gathered this information the same day and this is where the problem started.

I've emailed them 4 times, submitted the information online, and called six times. Nobody responded to emails......even the person that emailed me. The folks on the phone are no help.  I ask for billing and they place me on hold, then come back and act as if they can't reach anyone. I've never had an issue like this and frankly don't know what to do at this point. This company is extremely unprofessional and I am worried they will charge me $508 dollars. There's not much time left.

If I end up paying, can I file a claim to receive my money back? I thought about trying to find the CEO's email and let him know what's going on with his company. I am in California and wanted to see if anyone has dealt with this type of behavior.

I've also been charged about $25 in interest, and am wondering if that is typical or allowed w/medical debt. 

My reports do not show that the debt has been reported to any of the 3 CBs. 

Thanks in advance. 

today I got a text message saying they are going to charge my credit card on file in 10 days, but I never received their bill.

my insurance portal indicated they have received the claim from PF but they didn't not include any billing statement.

is this practice of charging credit card before letting patient seeing the bill legitimate?

what if the bill is erroneous and I need to dispute it.

We still haven't received the bill but yesterday the Medicare statement came in. Medicare Part B covers 80% of the approved Medicare reimbursement and the patient pays 20% of that amount. My research on Medicare.gov says no more than the approved Medicare reimbursement can be charged to the patient. So, here is a rundown on what the Medicare statement said:

Classic Air Care out of North Salt Lake City, UT 

Billed Medicare $64,400 (including mileage)

$10,435 Medicare Approved Amount

$8,264 paid to Classic Air Care

I have since found another dentist who aligns better with my preferences.
 

I contacted this previous dentist to cancel my appointment and to refund the amount (less whatever amount it was for the retainers). 
 

They are telling me that there is no refund and I would instead have to pay another $950, because as per the contract, 25% of the total invoice is the cancellation fee!!

How can they charge me when they haven’t even touched my teeth yet!! Can I file a credit card dispute the amount I paid? 
 

Will my account go to collections for the unpaid amount?
 

I’d appreciate any advice on how to deal with this please. Thanks!!

I am on Medicaid in Illinois and Froedtert basically did everything not to submit the bill to Medicaid, claiming they are out of network.

They wouldn't send medical records as required and itemization of services / procedures performed.

Instead, they have been billing directly to me. I am financially broke with Covid and everything, hence the state insurance.

After 6 months, trying to convince the hospital to submit a proper paperwork to the Medicaid to get paid, they sent me to the Americollect

and I received the first bill / notice. Insurance did paid several doctors from the hospital. The Medicaid is trying to sort the things out with 

Froedtert.  09/23 is the day they will have to come to some conclusion. But meanwhile, I want to prepare with any steps I can take. I am 55 and really have 

no pot to piss in. Can they go after me when I am on Medicaid ?

advising me that they received a judgement filed/dated July 2018.  I called the agency and it was from anesthesiologist charge from 2013.  

I was never served, even though there is an accompanying affidavit of service (I was able to get both docs from the court via email).  That affidavit is a joke, as

has a description of me that is hideously off -- even my skin and hair color although I like that they also made me twenty years younger lol. I am not trying to get out of paying but I would like to work out a payment plan. A few questions :

1) Are they allowed to freeze my Business Account for non business related debt?  

2)I am in private practice (psychologist).  My bank, Chase, will not allow me to  deposit credit card payments (they are actually virtual credit card payments received from one of the insurance companies until switch to direct deposit is completed) .  I was under the impression that deposits are permitted and only withdrawals (beyond the amount available)would be a problem.  A bit confusing.  (Also, virtual credit card payments are really more like debit/cash card payments , so there would be no issue regarding enough  funds available in the acct to cover, for example, if the "card" or deposit was  "bad" or could not be collected for some reason.  I have deposited many virtual card payments in the past.

3) I  retained a lawyer -- only to vacate judgement and perhaps see if a payment plan could be worked out.

I would appreciate thoughts re questions above, if possible, and any other advice , recommendations anyone can share.

Many thanks in advance!

P.S.  My credit has been good for some time now.  I really hope this does not show up.!  Haven't checked yet..