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akmama08

Medical bills in appeals in collections

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I flew across the country and had surgery Nov 1.  I paid the surgeon & hospital fees upfront.  That was what the surgeon quoted me (he was using his hospital rights).  Then bills came in from the hospital for various things...pathology, lab, etc.  I contacted them & said I wanted to submit to my insurance.  It was denied, so they did a submission directly & are appealing the denial.  I just got credit notifications that two items are in collections!  I never received any letters from the CA.  My beautiful credit I worked hard on (550 to 800+!) is now in the 600s!!!!!!!!!  I called CA & explained the situation.   They said they would remove it once insurance pays.  Anything I can dispute to get it off in the meantime?  We just had another baby in June, and took in another kid FT today, so need to get a home loan.  Now my CR is all messed up!!!

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Sorry, this is too recent to deal with in the usual manner. Have YOU appealed the denial to your insurance?? The only other thing you could do is to get a statement from your insurance as to what they would have paid if they had approved the charges and pay the charges directly to the provider with the HIPAA letter insert "a" ( after following the initial guides) and hope for reimbursement from your insurance.

https://whychat.me/GUIDEBOOK.html

 

https://whychat.me/GUIDE HIPAA PROGRAM.html

(insert a)
Enclosed please find my remittance of ($___) for payment in full of this account.
(insert this if the payment is less than billed)This payment in full is for services as per the attached fee schedule from
My insurance provider policy #
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

You should send the initial dispute letter to the CRAs so you would have a record in case the CAs mark the account as a paid collection.

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On 8/9/2019 at 9:27 PM, Why Chat said:

Sorry, this is too recent to deal with in the usual manner. Have YOU appealed the denial to your insurance?? The only other thing you could do is to get a statement from your insurance as to what they would have paid if they had approved the charges and pay the charges directly to the provider with the HIPAA letter insert "a" ( after following the initial guides) and hope for reimbursement from your insurance.

https://whychat.me/GUIDEBOOK.html

 

https://whychat.me/GUIDE HIPAA PROGRAM.html

(insert a)
Enclosed please find my remittance of ($___) for payment in full of this account.
(insert this if the payment is less than billed)This payment in full is for services as per the attached fee schedule from
My insurance provider policy #
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

You should send the initial dispute letter to the CRAs so you would have a record in case the CAs mark the account as a paid collection.

I have appealed it.  I didn't know the hospital submitted to insurance and got denied and are appealing as well.  It's messy because I went out of state.  My insurance requires pre-approval process, but I was too ill and couldn't wait.  Had to find a surgeon willing to operate on me while pregnant.  Insurance had approved the procedure locally by two surgeons who wrote letters stating they would not operate while I was pregnant.  I may not have survived the pregnancy if I didn't have the surgery.  I submitted an "exception to the rule" appeal after my denial...which got lost in the shuffle last month, so resubmitted recently.  It's a loooot of money.  Thousands.  But only one portion is in collections (anesthesia...billed separately).  I suppose we could charge on a credit charge (cringe) to get it off the collections and pay it off quickly.  I have a care credit card I could use with no balance and 0% interest the first year--doable.  Should I take their word on paying for delete?  
So you're saying to pay the hospital with that letter even though it is in collections?  Just want to make sure I'm doing it right since this scenario is a bit off from the norm?  I know the out of pocket is significantly less than what they are charging my insurance--I found out from my ins.  They're asking for about 12k more than me personally as a self-pay.  Also, how could I send that letter if I have to pay by credit?  I will see if care credit has checks.  
Thanks for your help, as always!  I'm trying so hard not to stress...but that is a huge drop.  155pts!!!  
 

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Posted (edited)

NO!! do not pay the hospital!bill! Pay ONLY the anesthesia bill and only after you find out how much your insurance would have paid for that if it had been approved. (the portion that is in collections (anesthesia...billed separately).  If the anesthesia bill (insurance rate)is over $2000. then don't pay that either. It will all sort itself out.

 

The main thing is to be happy that you and your baby are healthy. Opt out

https://whychat.me/GUIDEBOOK.html

and send the initial dispute letter to the CRAs for the account that is reporting.

https://whychat.me/hipaadisp.html

 

That way you will be in a better position to fix things once the insurance pays what they should.

 

Edited by Why Chat

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On 8/15/2019 at 6:07 PM, Why Chat said:

NO!! do not pay the hospital!bill! Pay ONLY the anesthesia bill and only after you find out how much your insurance would have paid for that if it had been approved. (the portion that is in collections (anesthesia...billed separately).  If the anesthesia bill (insurance rate)is over $2000. then don't pay that either. It will all sort itself out.

 

The main thing is to be happy that you and your baby are healthy. Opt out

https://whychat.me/GUIDEBOOK.html

and send the initial dispute letter to the CRAs for the account that is reporting.

https://whychat.me/hipaadisp.html

 

That way you will be in a better position to fix things once the insurance pays what they should.

 

Thank you, thank you!  I have the letters ready to go.  The bill is exactly 2k for anesthesia.  I'll get a check in the mail to them with the hippa (a) letter.  

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I am replying to your new post so that everything stays in one thread.

 

It will take a while for the hospital to process your payment with the HIPAA letter. I note that you said "Your check"?? The instructions are to get a bank money order, NOT a personal check. Did you at least add the restrictive endorsement to the back of the check??

https://whychat.me/hipltr.html

Please make sure that your payment is in the form of a bank cashiers check or bank money order,(do not use a postal money order). THIS IS CONSIDERED THE SAME AS A CASH PAYMENT, that you make a photo copy of the front and back of the remittance, that your name and address are CLEARLY printed on the remittance, that it is made to the order of THE ORIGINAL HEALTH CARE PROVIDER, and that you print or type clearly in the endorsement section "For Deposit Only to the Account of (name of H.C. provider)

Edited by Why Chat

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