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GoArsenal

Proof of false CA amounts question.

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Hello all,

 

So here's the problem (posted on Medical Board, no responses).

 

My DW's hospital invoice shows a portion of the bill was paid by my insurance, yet a CA collecting for the hospital are trying to claim the whole thing (the unpaid & the paid portion by my insurance).

 

We disputed and requested validation, and the CA responded with validation which included what has already been paid by my DW's insurance. The front page shows the whole amount, plus the combined charges on the second sheet do also.

 

Now this is only for a small amount, but I've been trying to get this off my DW's reports for a while now. This is a false and misleading representation of the amount, so that helps us big time.

 

My questions are, when I move to sue the CA, will they be able to claim a bona fide error?

 

Will the CA be able to get the case dismissed should the OC have messed up even though the invoice shows that the insurance paid their part?

 

Lastly, as I am in California and we can hold OC's liable under the FDCPA, is there anything I can do to put pressure on them to get this off?

 

Thanks.

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Hello all,

 

So here's the problem (posted on Medical Board, no responses).

 

My DW's hospital invoice shows a portion of the bill was paid by my insurance, yet a CA collecting for the hospital are trying to claim the whole thing (the unpaid & the paid portion by my insurance).

 

We disputed and requested validation, and the CA responded with validation which included what has already been paid by my DW's insurance. The front page shows the whole amount, plus the combined charges on the second sheet do also.

 

Gold.

 

 

Now this is only for a small amount, but I've been trying to get this off my DW's reports for a while now. This is a false and misleading representation of the amount, so that helps us big time.

 

My questions are, when I move to sue the CA, will they be able to claim a bona fide error?

 

Depeneds on whether they were notified. It they were notified CMRR, i would say no, they shouldn't.

 

Will the CA be able to get the case dismissed should the OC have messed up even though the invoice shows that the insurance paid their part?

 

Lastly, as I am in California and we can hold OC's liable under the FDCPA, is there anything I can do to put pressure on them to get this off?

 

Not sure of CA laws, hopefully someone will help with that.

 

Thanks.

Edited by jack1212

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Yeah, that's what I was thinking too. DW disputed with the CA via CMRRR, but I haven't notified the CA that the balances are different because they're supposed to go back to the OC for validation (LeFevre-Wollman; FTC letter). I've written up a letter, but don't want to send it just yet as I'm still modifying my bargaining tools while waiting for anyone else to chime in.

 

I should have been more specific though, the balance the CA claims includes what the insurance company paid, i.e. they are trying to make us pay for what has already been paid.

 

Bump...

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Have you asked the CA to provide you with information regarding anything that was paid by insurance, etc?

 

I would also write to the OC, inform them that their agent, the CA, is trying to collect money which has already been paid...and as such, they are violating the law...since they are acting as an agent for hte OC, and they claim that they received the information regarding the alleged debt directly from the OC (by providing that as "validation", which they are REQUIRED to get directly from the OC), you will be naming OC in any lawsuit that may become necessary...and tell them to recall it from the CA and have it deleted permanently

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Have you asked the CA to provide you with information regarding anything that was paid by insurance, etc?

 

I would also write to the OC, inform them that their agent, the CA, is trying to collect money which has already been paid...and as such, they are violating the law...since they are acting as an agent for hte OC, and they claim that they received the information regarding the alleged debt directly from the OC (by providing that as "validation", which they are REQUIRED to get directly from the OC), you will be naming OC in any lawsuit that may become necessary...and tell them to recall it from the CA and have it deleted permanently

 

Don't most hospitals agree to co-pay only when accepting insurance contracts?

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not exactly...

 

they agree to an agreed upon price...let's say it's "normally" 1500 bucks for a procedure (taking your temp)

 

 

they negotiate it to 179 dollars with your insurance company...

 

 

your insurance company pays 150 of that due to deductibles

 

you have a 20 dollar copay...which you paid in advance...and is over and above whatever the insurance company negotiated

 

 

the 29 dollars left over is your responsibility....

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