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champ123

Medical Collection Problem

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My optomatrist incorrectly submitted my claim to my insurance and then came after me for the amount they claimed I owed. I haven't been able to get it sorted out after numerous calls to my insurance carrier and I am now receiving collection letters. What is the best way to handle this? I have spent a ton of time already dealing with this but refuse to pay them money I do not owe. They don't even have a record of my copay, it's ridiculous. 

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You discuss communications with your carrier, but what about communications with your provider?  Did you keep them in the loop, including going in to discuss the issue and potentially getting them to resubmit the claim?  If not, WHY NOT?

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Follow the guides

https://whychat.me/GUIDEBOOK.html

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

 

Is the collection account reporting?? If so, send each CRA where it is reporting this;

https://whychat.me/hipaadisp.html

 

What was the date of your optometrist visit?

Does your insurance normally cover such visits? 

Did you give your optometrist your insurance information at the time of your visit?

If it was covered get your EOMB ( explanation of medical benefits) from your insurance Co.

 

If the optometrist's office incorrectly coded the visit request they correctly re-submit it with the following (edited for your purposes) HIPAA letter;

(Your Name)
(address)
(City,State, zip)
s.s.# (social security #)
HIPAA Compliance Office
( health care provider creditor)
(address)
(date)
Dear Sir/Madam;
This letter is in reference to (account #) for services provided to (name of patient) on (date of service).
In regard to the bill on this account in the amount of ($___):

This account is a billing error.
(1)
The deductible 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 (include EOMB) I hereby request that you properly and promptly resubmit to my insurance to obtain the balance due.

 

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.

 

Please be advised that under Federal Statutes. the Fair Credit Reporting Act, (15 U.S.C. § 1681 et seq) and SEC. 13407(1) BREACH OF SECURITY.This means, with respect to unsecured PHR identifiable health information of an individual in a personal health record, acquisition of such information without the authorization of the individual. you may be held liable for the actions of (collection agency name). 


(a) Duty of furnishers of information to provide accurate information.
(1) Prohibition.
(A) Reporting information with actual knowledge of errors.


A person shall not furnish any information relating to a consumer to any consumer reporting agency if the person knows that the information is inaccurate.


Your furnishing of my account information to (collection agency name), is not in compliance with HIPAA, and any subsequent reporting of this account on my credit reports to (credit reporting bureaus) is a clear violation of Public Law 104-191 ("HIPAA") since there can be no permissible business purpose in divulging protected health information to anyone on an account once there is no longer any payment due.In addition the new Omnibus Final Rule states:when patients pay out of pocket in full, they can instruct their provider to refrain from sharing information.This letter serves as that instruction


Therefore I am requesting you promptly rescind all such account information furnished to (collection agency) and require them to purge their records of all reference to this account, and that you insure that any and all reporting of this account is immediately deleted from my credit reports.


This simple procedure to request the deletion of ALL reference to this account from the records of ( collection agency name) and to require them to have this account information deleted in its entirety from my credit reports will resolve this problem completely.


Please respond, in writing within 10 days that you are processing this request.


I am reserving the right, to take appropriate legal and civil action including reporting to any applicable regulatory authorities any lack of cooperation or compliance with this request.


I hereby waive my rights under HIPAA and any State Privacy Act for the single purpose of your transmission of this request and accompanying documentation in any required report you must make to your E &O insurance carrier.
Sincerely,
signature
(Your Name)

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Thank you. I was able to find out that they billed my insurance for a deductable twice, one for each "procedure" when they are only suppose to bill a single deductable per visit. I'm pretty sure they knew this but billed them anyway thinking they would just come after me for the amount not paid. People complaing about insurance companies a lot however, many doctors, especially large practices like this optometrist do some very shady things. I will follow the advice given here, thanks again.

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Your claim that they 'billed' for a deductible is confusing to me...every health insurance carrier I ever had was set up so that there was a co-pay at the time of the visit and things like deductibles were internal to the carrier.  There was no 'billing' of a deductible.  The provider sent in the claim (let's say $150) and the carrier essentially looked in the system and either the deductible had been satisfied or it had not been satisfied.  If it hadn't been satisfied, then I was on the hook for whatever was left and, if it HAD been satisfied, then a payment went to the provider and I MIGHT have some residual amount remaining depending on the quirks of that year's deductibles and the percentage of a claim covered by the policy.  

 

Granted, I self-insure now and don't have to deal with insurance companies, but I doubt the billing has changed even though the options post-ACA have become far more limited...

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I suggest that you also check your State's consumer protection  agency and IF the Dr. does not fix this "problem" ( which may not be an error but a fraudulent scheme to pad their reimbursement from insurance) you can file a complaint with them also.

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