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I had to go to the ER for a dislocated shoulder in 2017

The hospital was in network but the Dr that I never saw wasn't. 

I don't have and can't get that EOB and I'm no longer with that insurance company. 

 

Any ideas on what to do? 

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Whychat, I finally got copies of the EOB for this collection. UHC had to go into their archives to find it. 

 

It clearly says "your claim was processed using your network benefits, the physician is not in the network. The provider may bill you for the balance of the unpaid portion. 

 

When they knock you out to reset a dislocated shoulder you can't ask, "do you take my insurance"? 

I, as many people would think if the hospital is in network the Dr's should be too. 

Idk what to do I surely don't have that kind of money!

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Have you tried getting your insurance to pay for this out of network provider ??It should be covered to SOME extent under emergency services. At the same time find out what they WOULD have paid (the allowed amount) if he HAD been within network.

 

Did you follow the guides??

https://whychat.me/GUIDEBOOK.html

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

 

The initial dispute letter should get you some results.

https://whychat.me/hipaadisp.html

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They paid 76.38 and that's it. 

In network would have been 100% because my deductible was met earlier during the year. 

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Are you saying that your insurance paid this bill??"They paid 76.38 and that's it. " If that is what the EOMB says it paid what does it say about what the APPROVED amount was??

 

Please let us know if you have done ANY of the steps suggested.

 

 

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Posted (edited)

The total bill was 466.90 the insurance paid 75.56 (sorry I made a mistake on what they paid) leaving "the amount you owe the provider is 390.44".

Exact wording on the EOB is:

"The claim was processed using your network benefits. The physician is not in the network. The provider may balance bill you. but you are only responsible for co-insurance, co pay or deductible. It you get a bill for more then $500 or more over your member responsibility, you may have the right to ask for mediation of the claim amount. You can get more information at www.tdi.texas.gov/consumer/cpmmediation. You can also call customer care at the number on your ID card if you get a bill for any mount over your member responsibility." 

The services were provided in Louisiana but the bill from the Dr has a Fort Worth address. 

 

I don't remember what the out of network policy said or what the deductible or co pay was at the time. 

 

I did file an appeal on this claim through UHC but never got an answer it was removed from my credit then put back on in March of this year. DOS was 11/23/2016

Ins paid 12/29/2016 This policy cancelled 12/31/2016 as it was no longer offered by UHC. 

 

Edited by gdtobefree

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25 minutes ago, Why Chat said:

Is it on all your reports??

Follow the guides to get it deleted.

What State are you in NOW??

Louisiana has a 3 year SOL for this type of account;

https://whychat.me/States/state-la.html

It's only on Experian

I have always lived in Louisiana The Dr has a TX address I guess for his billing 

Does the SOL go by the DOS? If so then its past SOL by 6 mos

Will follow process, Thanks 

 

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@whychat

Ex received my hand written dispute on June 16th. Patiently waiting............

Do they have the standard 30 days to come to a resolution or deletion? 

 

 

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@whychat United Recovery updated my reports dated 6/19/20

I haven't gotten anything in writing from EX yet but did get an alert that an account was updated. I logged in and the alert said it was URC. 

 

Now what? 

 

 

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What have you done so far?

https://whychat.me/GUIDEBOOK.html

opted out and deleted old addresses?

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

Sent the CRAs the initial dispute letter?

https://whychat.me/hipaadisp.html

Sent the CA the medical DV?

https://whychat.me/ltrcavalhipaa.html

Sent the CRA the follow up dispute?

https://whychat.me/ltrcavalhipaa.html#DISPUTE

 

If you have done all the above and Ex ( the only CRA reporting??) has NOT deleted then the next step is to file a dispute with the CFPB

 https://whychat.me/hipaaftccomp.html

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3 hours ago, Why Chat said:

What have you done so far?

https://whychat.me/GUIDEBOOK.html

opted out and deleted old addresses?

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

Sent the CRAs the initial dispute letter?

https://whychat.me/hipaadisp.html

Sent the CA the medical DV?

https://whychat.me/ltrcavalhipaa.html

Sent the CRA the follow up dispute?

https://whychat.me/ltrcavalhipaa.html#DISPUTE

 

If you have done all the above and Ex ( the only CRA reporting??) has NOT deleted then the next step is to file a dispute with the CFPB

 https://whychat.me/hipaaftccomp.html

I'm on step one of your HIPAA dispute with the CRA. I haven't done anything else. 

The next step of your program says if it comes back verified to pay it.  I don't have the money to pay it! 

Since he was not in my network but the ER was could I negotiate it lower with the Dr.'s office?

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The next step is NOT to pay it if "verified". READ THE WHOLE PARAGRAPH!!

If the accounts are verified AND you receive a response FROM THE REPORTING CA ( Collection Agency) with account details that MATCH your records, you can then pay the ORIGINAL CREDITOR HEALTH CARE PROVIDER directly using the HIPAA letter insert "a", be sure to follow ALL the directions

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What is your problem??

Have you sent the CA the medical DV??

Have you sent the CRAs the follow up dispute??

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14 hours ago, Why Chat said:

What is your problem??

Have you sent the CA the medical DV??

Have you sent the CRAs the follow up dispute??

I was keeping you looped in on the progress. 

Thanks for your help sorry to have bothered you. 

 

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No bother-- " keeping you looped in on the progress" is of little value if you don't tell us what you have done, or not yet done. 

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I sent the CA a DV no response

Sent the CRA your hand written in blue ink dispute letter 

I haven't heard a word from either! 

The CA updated in July 

The CRA never marked the account as being disputed. 

At this point I have been completely ignored by both. 

 

Follow up letters to CA and CRA? Is that correct? I am asking to verify the correct procedure, I know your system works I just don't want to make a mistake. 

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I think you are confused--- and getting ME confused as well.

You appear to have reversed the order of the letters!

When did you send the initial dispute letter to the CRA ( only 1 reporting?)

 

You say you had NO response from the CRA?? and it is NOT reporting as disputed??

How are you checking your results?? If you have previously signed on to the CRA are you SURE you are getting an updated report??

 

 

 

 
Posted response

 

 

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5 hours ago, Why Chat said:

I think you are confused--- and getting ME confused as well.

You appear to have reversed the order of the letters!

When did you send the initial dispute letter to the CRA ( only 1 reporting?)

 

You say you had NO response from the CRA?? and it is NOT reporting as disputed??

How are you checking your results?? If you have previously signed on to the CRA are you SURE you are getting an updated report??

 

 

 

 

Posted response

 

 

Yes I have checked my actual EX reports. I sent it to the cra which is EX. I have not gotten anything from them at all. Sent in June. Received on June 8th. It was never marked as in dispute on my reports. 

I am going directly through Experian to check my reports. 

 

 

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