Medical Data Systems & HIPAA - just want to verify I'm doing this right

[LearningToFly]

Just making sure I'm on the right path with this one (following Whychat's method and don't want to get any steps wrong). The collection below is reporting on all 3 CRAs. This is from a date of service of January 2012.

 

Collection on debt to: Highlands Medical Center

The collection agency "Medical Data Systems I" was hired to collect a debt of $582 originally owed to"Highlands Medical Center" on account number "XXXXXXX".

Collection agency [?] Medical Data Systems I Original balance [?] $582 Current balance [?] $582 Date assigned [?] Mar 22, 2013 Original lender [?] Highlands Medical Center Account number [?] XXXXXXX Account holder [?] Individual

 

I sent the first dispute letter to the 3 CRAs, and am awaiting EX's response before moving forward, but TU and EQ have responded with 'verified that this item belongs to you' and the following info:

 

Medical Data Systems; Collection Reported 08/2013; Assigned 03/2013; Creditor Class - Medical/Health Care; Client - Highlands Medical Center; Amount - $582 ; Status as of 08/2013 - Unpaid; Date of 1st Delinquency 01/2012; Balance as of 08/2013 - $582 ; Individual Account; Account # - LTFxxxx

As soon as I receive the same type of correlating response from EX, I plan to send payment in full to the OC along with the Letter to Health Care Provider (insert a) from Whychat. After that certified check is deposited, I will then send the follow-up letter to the HIPAA compliance dept. of the OC, EX, EQ & TU.

Is this correct and is there anything I'm missing? Thanks in advance.

[BigDaddyof8]

Did you delete all old address first?

[Why Chat]

The OP does not need to delete old addresses for accounts that are that recent.

 

He does need to check his EOMBs ( explanation of medical benefits) from his insurance to make sure that the billed accounts are accurate and correspond to "patient responsibility" and are not improper/illegal "balance billing".

 

You should NOT rely on a simple "verification" from the CRAs to prove that the reporting CAs are in a current business relationship with the OC. IF the reporting CAs RESPOND to you because of your disputes to the CRAs, THAT is what you need to make sure that they are in a current business relationship.

 

Otherwise, if all you get is "verification" from the CRAs then you need to go to the next step and send the medical DVs.

 

Frequently an account is "bundled" with other left over written off accounts ( written off balances because of insurance discounts) and the CAs get these accounts improperly. Sometimes the insurance is resubmitted because of billing errors on the part of the OC and the CA does NOT have updated information.

[LearningToFly]

Okay thanks Whychat. This helps a lot. So I'll check my EOMBs (I should have all that because this was part of an auto accident & I've kept records) and then I'll send the medical DVs.

 

Will update this thread if I have additional questions (and to report my success I hope!) in case others are dealing with the same CA in similar circumstances.

[LearningToFly]

Okay, maybe I don't know what I'm looking at. I pulled up the original bill from the OC, and the EOB from my insurance provider. The information from the insurance provider EOB is below. Any thoughts on how I can tell from the info below that I am in fact supposed to be responsible for the total $582.60? Anything else I should be looking at to determine what I truly owe? Thanks in advance for any input - not so familiar with medical billing. (I redacted personal information below by replacing procedure descriptions with 'service 1', etc.)

 

Service 1: Billed: 213.00 Insurance Rate: 170.40 Plan paid: 18.36 Coinsurance: 2.04 I pay: 150.00

Service 2: Billed: 166.00 Insurance Rate: 32.80 Plan paid: 119.52 Coinsurance: 13.28 I pay: 0

Service 3: Billed: 462.00 Insurance Rate: 369.60 Plan paid: 332.64 Coinsurance: 36.96 I pay: 0

Service 4: Billed: 265.00 Insurance Rate: 212.00 Plan paid: 190.80 Coinsurance: 21.20 I pay: 0

Service 5: Billed: 1620.00 Insurance Rate: 1296.00 Plan paid: 1166.40 Coinsurance: 129.60 I pay: 0

Service 6: Billed: 2173.00 Insurance Rate: 1738.40 Plan paid: 1564.56 Coinsurance: 173.80 I pay:0

Service 7: Billed: 540.00 Insurance Rate: 432.00 Plan paid: 388.80 Coinsurance: 43.20 I pay: 0

Service 8: Billed: 70.00 Insurance Rate: 56.00 Plan paid: 50.40 Coinsurance:5.60 I pay: 0

Service 9: Billed: 86.00 Insurance Rate: 68.80 Plan paid: 61.92 Coinsurance: 6.88 I pay: 0

So the totals are:

Insurance Rate: 4476.00

Insurance Paid: 3893.40

Coinsurance: 432.60

"You Pay": 150.00

Total Coinsurance & "You Pay" together 582.60

Also to BigDaddy's point for general purposes, the only two remaining addresses I have on CRAs are current (<1 year) and previous. All the OCs for the medical stuff have both of these addresses on file.

Edited August 22, 2013 by LearningToFly

[Why Chat]

Okay, maybe I don't know what I'm looking at. I pulled up the original bill from the OC, and the EOB from my insurance provider. The information from the insurance provider EOB is below. Any thoughts on how I can tell from the info below that I am in fact supposed to be responsible for the total $582.60? Anything else I should be looking at to determine what I truly owe? Thanks in advance for any input - not so familiar with medical billing. (I redacted personal information below by replacing procedure descriptions with 'service 1', etc.)

 

Service 1: Billed: 213.00 Insurance Rate: 170.40 Plan paid: 18.36 Coinsurance: 2.04 I pay: 150.00?? deductible??

Service 2: Billed: 166.00 Insurance Rate: 32.80 Plan paid: 119.52 Coinsurance: 13.28 I pay: 0

Service 3: Billed: 462.00 Insurance Rate: 369.60 Plan paid: 332.64 Coinsurance: 36.96 I pay: 0

Service 4: Billed: 265.00 Insurance Rate: 212.00 Plan paid: 190.80 Coinsurance: 21.20 I pay: 0

Service 5: Billed: 1620.00 Insurance Rate: 1296.00 Plan paid: 1166.40 Coinsurance: 129.60 I pay: 0

Service 6: Billed: 2173.00 Insurance Rate: 1738.40 Plan paid: 1564.56 Coinsurance: 173.80 I pay:0

Service 7: Billed: 540.00 Insurance Rate: 432.00 Plan paid: 388.80 Coinsurance: 43.20 I pay: 0

Service 8: Billed: 70.00 Insurance Rate: 56.00 Plan paid: 50.40 Coinsurance:5.60 I pay: 0

Service 9: Billed: 86.00 Insurance Rate: 68.80 Plan paid: 61.92 Coinsurance: 6.88 I pay: 0

 

So the totals are:

Insurance Rate: 4476.00

Insurance Paid: 3893.40

Coinsurance: 432.60

"You Pay": 150.00

Total Coinsurance & "You Pay" together 582.60

 

Also to BigDaddy's point for general purposes, the only two remaining addresses I have on CRAs are current (<1 year) and previous. All the OCs for the medical stuff have both of these addresses on file.

Do you have co-insurance?? Was there co-insurance from your auto insurance policy?? What did the auto insurance pay??

 

I don't think you owe anything more than perhaps the $150 deductible

[MamaLlama]

We have a coinsurance in addition to our deductibles with our health coverage. We would be responsible for both sections. Just my two cents.

[LearningToFly]

The only insurance at play here is the health insurance. The auto insurance refused to settle so I've hired an attorney and filed suit. We're almost at the two year mark and no end in sight on getting the auto insurance company to settle. There have been a few other medical co-pays that have gone to collections in addition to this one, but those have all fallen off using step 1 of the HIPAA process.

 

There is also one bill of around $2k that health insurance refuses to pay unless I send them something saying that the auto insurance has paid all it will pay (which I won't do since it would negate my case). The upshot is, there are doctors in that group I need to see and can't until I pay the outstanding balance (the appointment setters won't let me in until the outstanding balance is paid by someone). It's been an extremely challenging situation.

[Why Chat]

I understand that your auto insurance has not yet settled, ( 3 & 1/2 years is average if you have a good case and a good lawyer), however, your medical bills should have been paid by the auto insurance ( possibly yours with their ability to be repaid by the other person's insurance at settlement). The reason I say this is because your EOMBs seem to indicate that a secondary insurance DID pay minus a deductible, which indicates that it was YOUR insurance that paid.

 

Check with your lawyer to see who paid what, check with YOUR auto insurance to see if they paid anything.

[LearningToFly]

Okay, a little more information.

 

I was a passenger, driver of the vehicle I was in and the person who hit us (turned from the outside lane, without right of way, into oncoming traffic and hit us head-on - got lots of violations at the scene) had the same insurance carrier. That carrier has paid $0 and my personal vehicle insurance (who my attorney included for underinsured motorist purposes) has paid $0. It appears that the $150 is my deductible and the co-insurance is the portion my health insurance finds me responsible for (same sort of setup MamaLlama's insurance uses).

 

So at this point I'd send this letter: http://whychat.5u.com/ltrcavalhipaa.html to the CA, am I following you correctly?

[Why Chat]

Could you re-check with your lawyer and find out IF your car insurance or IF the car insurance for the at fault driver was ever billed for these charges?? Can you find out if the health care providers were ever given the insurance data??

 

It is possible that neither your lawyer or the insurance Co. were ever provided notice of these bills.

 

And hold off sending out anything further to anyone until and unless you get the correct information.

 

Normally when a car accident is involved the health care providers are given the policy #(s) of the car insurance.

[LearningToFly]

Okay got it. I'll pursue that with the attorney and update when I have more info.

[LearningToFly]

Spoke with attorney's office and health insurance provider. Auto insurance has not been billed for any of my medical balances. The providers did not receive policy information (I don't have the other drivers' policy info) and the claims have not gone to the auto insurance providers, but we rolled all these balances into the damage claims. Prior to hiring an attorney, I spoke with the claims adjuster for the auto insurance and in going back through those messages, they only pay property damage up front; medical reimbursement is included in settlement.

 

In talking with my insurance provider, I found out that I have an annual $200 deductible (which explains the $150 in this case that remained) and a 10% "co-insurance" for non-preventative care up to $1250 (at which point they cover me for 100% instead of 90%). So $150 is my deductible, and $432.60 is the 10% I'm responsible for on my plan.

 

So at this point, if I owe the $582.60 I can pay it if needed, and will get it in the back end when the case settles. I just need to get the collection off of my reports as part of that process and want to follow the most effective steps to make that happen.

 

I'm trying to buy a vehicle (as soon as possible - mine is on last legs) and this is the last collection on my reports. The only other real negs are a CO Merrick CC that is unpaid, an old HSBC paid CO that is about 7 years old (but still reporting - working on that), and a Santander car loan that shows as a paid collection (purchased from Citi who misapplied payment arrangements).

[Why Chat]

OK,

 

I suggest you wait for the results of the initial dispute letter to the CRAs

 

http://whychat.5u.com/hipaadisp.html

 

If you get a response from the reporting CA, or if the data you have already received is a result of your initial dispute, then pay the OCs with the HIPAA letter insert "a".

 

http://whychat.5u.com/hipltr.html

[LearningToFly]

Okay, got it. Thanks so much Whychat! Really appreciate your help - I've deleted several med baddies already thanks to your excellent advice - hoping this one goes the same.

[LearningToFly]

One more question... about to pay this and contacted the medical provider's office (a hospital in a very small town) to get the correct payment address. The lady in the business office stated that if I paid in full at one time, I could pay the discounted price of $378.69 instead of the billed amount of $582.60. I asked her if upon payment they would recall this from the collection agency. She stated they would not, but would have the collection agent update the account as a paid collection.

 

I plan to still follow the HIPAA method and send the payment with HIPAA insert letter "a". Do I need to pay the full $582.60 to be safe, or can I pay the discounted $378.69? I was unable to secure anything in writing regarding the discounted amount. The payment address she gave me is the lock box for the hospital, not an address for the collection agent.

[Why Chat]

Pay the $378.69 and change the insert "a" to this:

 

• Enclosed please find my remittance of $378.69 for payment in full of this
  account.
• This payment in full is for services as per the instructions from your business office representative ( name of woman if you have it) provided to me on x/xx/2013 at x.xx (AM-PM).
• Please note, my remittance is payable ONLY to (hc provider) and may not be
  signed over or transferred to any third party collection agency, as this would
  constitute an additional violation of HIPAA, State Privacy Act rules and the Omnibus Final Rules.
  .
• Copies of this correspondence and a copy of the remittance check may be used
• for any further actions with State or Federal agencies

[LearningToFly]

Got it! Thanks WhyChat. I'll keep this thread updated and hope to post a successful deletion soon.

[LearningToFly]

UPDATE:

 

• Mailed HIPAA plus modified insert 'a' (as instructed above) with payment on 10/7/2013.
• Certified mail delivery confirmed on 10/9/2013.
• Confirmed payment was deposited by Highlands (parent company of original provider) on 10/11/2013

 

As of today 10/22/2013 I have received nothing from Highlands, and the account has not updated on my CRs whatsoever. I am thrilled to see it did not update as a paid collection, but was hoping it would disappear from my reports as I'll be applying for a vehicle loan this week. Is there anything else I need to do at this juncture, or just wait for the 30 days from receipt to follow up with Highlands?

[Why Chat]

Because of your timeline crunch, I suggest you send the follow up dispute to the CRA(s) now, you can wait until you see what the result of the follow up dispute is before sending a copy to the OC with the cover letter:

 

INSTRUCTIONS FOR FOLLOW UP TO "HIPAA" LETTER TO ORIGINAL CREDITOR HEALTH CARE PROVIDER ALL FURTHER CORRESPONDENCE SHOULD BE SENT CMRR

1- Make sure any money order has been deposited ,or you have received a return receipt from your letter if insert "b" or "c" were used. 2- Send the follow up letter posted below. Letter To Cra After HIPAA Letter, send CMRR Use this AFTER you have received the green card back and received verification that any money order has been deposited (if using insert "a")

 

 

 

 

To Equiexptu Sirs;

 

This is a dispute of account information on my credit report, (report #)

 

Please re-investigate (or investigate if you have not previously disputed) the following disputed account on my credit report. (give CA name and acct. #)

 

Please furnish me with verification that (CA name) is reporting this account from (OC name) for ($ amount) in my name.

 

I require the identification of the reporting party and the date of their verification. I require documentation of the authorized HIPAA business relationship between (CA name)and (OC name) and documentation of your authorized HIPAA business relationship between yourself and either ( name of CA) or (name of OC).

 

Please be advised that this request is being made in accordance with the requirements of the FCRA and FACTA and the privacy rules of the HIPAA and (your State)'s Medical Privacy Act. Please be advised that you are subject to the penalty rules of the HITECH Act as issued 11/30/2009 and Omnibus Final Rules effective 09/23/2013.

 

Please note that your Credit Reporting Agency is now subject to Federal consumer financial laws, including, among others, the FCRA and Title X of the Dodd-Frank Act, and related regulations including a ban on “Abusive” Acts or Practices.( Section 1031 of the Dodd-Frank Act )

 

Sincerely, Ido N Tnow

Edited October 22, 2013 by Why Chat

[LearningToFly]

Mailing today. I'll keep you posted on the outcome.

[LearningToFly]

I'm awaiting confirmation from the three credit bureaus that investigations are complete and removal is confirmed, but as of this morning (on EIDTMPM & USAA) this collection is gone x3. Pulled FICOs and they jumped: EX: 609 to 638, EQ: 554 to 597 and TU: 570 to 629. Time to buy that car.

Thank you seems inadequate WhyChat - your help has been truly invaluable.