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DISPUTING MEDICAL ACCOUNTS

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The HIPAA letter program is a good way to pay the OC and obtain a deletion of the CA from your reports, however, many people posting here do not understand that the FIRST thing to determine is if the account is "real".

 

Let me give you an example,

Someone goes in for an expensive diagnostic test like an MRI to a Hospital.

They have insurance that has a deductible.

They pay the deductible and forget about the bill.

The procedure costs $1,000. The deductible is 20%= $200..

 

HOWEVER, the Hospital has a contract with the insurance to accept payment based on THEIR schedule, which allows $500. for the MRI.The insurance pays the Hospital $400. ( allowing for the 20% of $500.=$100.) The hospital then should "writes off/discount" the balance of $500.

 

Now, the Hospital billing Dept., instead of sending a corrected bill to the patient, with a refund of the $100. deductible overpayment, turns this over to a CA to collect $400.more from the patient.

 

Unless you keep track of all your bills, and keep good records of what the insurance has paid, and are at the same address, you will get SHAFTED by this

improper and illegal billing.

 

For people on medicare and many other types of insurance, the PROPER procedure is to bill the patient for the CORRECT deductible based on the schedule that they have for what is allowed, however, even when they do this, it still can get royally screwed up.( I can attest to this, as I am in the middle of days of marathon telephone sessions with Medicare, the OC provider, and their billing department for a family member)

 

So, the HIPAA program starts with the medical dispute letter to the CRA, to make sure there IS a legitimate bill, and if you have any type of medical treatment anywhere, KEEP ALL YOUR RECORDS for at LEAST 7 years.

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That is so tru Whychat. I am helping my sister who had surgery and paid all her medical bills back in 99. Now there are 2 medical collections on there and we are having heck trying to figure out if they are her bills or not and whether they ever got submitted to Medicare at the time.

 

In my case I also have a bill I am fighting where the hospital sent the Medicare write off portion to collection. I have the Medicare notification that proves it was to be written off but it was not done.

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Something should also be mentioned about hospitals that overcharge/overbill patients who have no insurance. If you have insurance the insurance company will put a cap on what can be charged for a particular procedure preventing the OC from soaking the insurance company. Those who have no insurance have no clout to prevent this from happening to them and, unfortunately, many hospitals soak the very people who can afford it the least. Since these people have no one to fight for them and can't pay the inflated costs being billed to them wind up in collections with their credit ruined. If the hospital gave the same courtesy of putting a cap on billing for certain procedures to patients without insurance maybe these people could pay it and prevent ruining their credit. This is the worst case of going after the little guy I have heard of and it should be stopped.

 

In my case I was on a sliding scale at the hospital only supposed to pay 20% to the hospital because of a government program based on ability to pay. The government pays them the rest. However, they were inflating the prices of all procedures and then giving me the 20% off so the amount was still astronomical for the procedures being done. In this way they were not only overcharging me but choking the Federal government for the rest. This is for them like having the best of both worlds. Big insurance companies can get treated fairly but why not bilk the federal government and low income patients - by not putting a cap on what they can bill - as long as they can get away with it? (I have also found evidence of their double billing me for a treatment I already paid for and now they have reported that one on my CR which I am working on getting off now.) The government should demand the same courtesy that an insurance company gets. Or maybe they do give the government a break and only the poor unsuspecting patient is the one being overcharged because they are the ones not in the loop! I personally think it is dispicable to charge the most to the people who can least afford it and use a government program to get away with doing so.

Edited by lorcan

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Here is an MSN article along the lines....

 

http://moneycentral.msn.com/content/Insura...alth/P74840.asp

 

 

Yep, they tried to charge me the extra overage from the negotiated insurance price, and are trying to get monies for services not rendered.

 

This is insurance fraud plain and simple. After doing some searching I have found that this is common in the medical industry. I know the government is cracking down on this and has been reimbursed Millions of dollars

 

I have learned from this, from now on I want a detailed bill not a statement.

 

Deby

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