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Doctor Office Visit Bill Sent to Collections

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"Amanda" in my family visited her physician [A] last fall for the purpose of an annual preventative care visit.  As the case in previous years, she expected her visit to be covered by (High Deductible) insurance in full, as it was for preventative care under the Affordable Care Act. She later received a bill for $175 from the medical provider company, which is a large not-for-profit chain that includes hospitals.  The bill matched the insurance EOB, with the billed amount adjusted to the insurance company in-network price for an office visit (Not the expected preventative care visit). 

 

  She called the office where the care was provided several times and was told that this must be a mistake, since the person who answered the phone could see the appointment was for preventative care. Eventually that story would change over months "to we billed you for an office visit because you brought up a [healthcare concern] and we did tests."  Ironically nearly all of those tests were written down to $0 due by insurance, because earlier in the day she visited her internal medicine doctor for an annual preventative visit and the same tests were done in-network.  If both visits/tests had not happened same day, she likely would have been on the hook for far more.  Fortunately the insurance company caught that and since all is in-network, the provider couldn't bill a second time for tests done on the same day. (Why they would even perform the same tests twice, since both physicians [A] and are in the same company, is another matter, but unrelated to billing). 

 

A cycle of new bills and repeated phone calls continued for about 2-3 months.  Then the $175 bill from the provider disappeared, followed by a letter from an out-of-state collections company (CA).  Amanda sent a dispute validation letter, and the CA responded with a copy of the charge from the healthcare provider (strangely it shows another address, but company name is correct).  Meanwhile the healthcare sent a new bill for one test that the insurance company allowed for about $20.  Amanda eventually just paid the $20 for that test; it never went to collections. 

 

So Amanda has $175 outstanding medical bill debt with a CA.  While it is annoying that the "preventative care" visit was converted into something else with a $175 charge, Amanda is prepared to pay.  But she wants to ensure that it never hits a credit report (or is removed if it is added).  I read the HIPAA letter suggestions, however that appears only for 3rd party CA, and this CA has a direct relationship with the healthcare provider's central billing office.  I am curious what they sold the debt for and would offer that amount to pay, but will likely never know. Ironically Amanda would have just paid the provider before CA if there had been a clear explanation, starting from the day of service to the various phone calls. 

 

What is the right way to proceed and ensure there  are no surprises?  Would the CA accept less than 175 as payment in full?  Can we keep the charge off of credit reports?  Does the 180 days for credit reporting begin from the original date of visit or the date it was turned over to collections (roughly 5 months after the visit).  We've never dealt with collections and want to do everything right and avoid credit report nightmares later. Thanks!

 

 

 

 

 

 

 

 

 

 

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Follow the guides;

https://whychat.me/GUIDEBOOK.html

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

Send each CRA where this is reporting this;

https://whychat.me/hipaadisp.html

 

IF she gets a response from the CA AS A RESULT OF THE DISPUTE LETTER she can then pay the Dr. directly with the HIPAA letter insert "a"

https://whychat.me/hipltr.html

with EITHER the full amount OR the amount that should have been charged from her EOMB

 

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 EOMB

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 a violation of HIPAA
Copies of this correspondence and a copy of the remittance check may be used for any further actions with State or Federal agencies

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(I'm not sure why the font changed / got bolded in the original post or how to fix that).

 

The collection agency confirmed a relationship with the original creditor, and the original creditor's payment page even has a link to the collection agency, so I think this is legitimate.

 

The original creditor is a large medical company (non-profit) with both doctor offices and hospitals, and a central billing office. The billing office has said that any payments to them for accounts turned over to collections will just be returned.  How will the form letter work if I send it to the original creditor, because their procedure is to return the payment made to them now that it is with collections?  

 

Also, the letter mentions, "subtitle D of the ARRA."  It doesn't mention what 'ARRA' is, or more importantly what the statue citation is e.g. XX USC 123 it refers to, so this may be unclear to the recipient.   Is the 'omnibus final rule' referring to something under 45 CPR? 

 

Thanks for your assistance!

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6 hours ago, PreventativeCare said:

Also, the letter mentions, "subtitle D of the ARRA."  It doesn't mention what 'ARRA' is, or more importantly what the statue citation is e.g. XX USC 123 it refers to, so this may be unclear to the recipient.   Is the 'omnibus final rule' referring to something under 45 CPR? 

 

Thanks for your assistance!

https://en.wikisource.org/wiki/American_Recovery_and_Reinvestment_Act_of_2009/Division_A/Title_XIII/Subtitle_D

 

Looks like something slipped into the final passage of the ARRA which was the previous "stimulus" before the current "stimulus" (CARES Act).

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The HIPAA letter with payment can be abridged as follows for your purpose;

(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 ($___):

Enclosed please find my remittance of ($___) for payment in full of this account.
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

 

Please be advised that under Federal Statutes. the Fair Credit Reporting Act, 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). 
The Privacy Rules prohibits a covered entity from using or disclosing an individual's protected health information  unless specifically authorized by the individual or otherwise allowed under the Privacy Rules.
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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Posted (edited)

Follow up:  She just checked all three major credit bureaus today and there is NO negative information at this time.  So she doesn't need to ask them to remove any negative information, but does need to ensure that this collection/bill doesn't appear in the future on credit reports.

 

If she sends a money order to the original creditor (healthcare company) with the HIPAA letter, she likely will never know if it is cashed or not cashed. Would a check be better?  She can get a money order from a credit union, but their branches are closed at the moment and she would still not know if it gets cashed or if more attention is needed.   There doesn't appear to be a HIPAA violation as the collection agency has a relationship with the original creditor. Still trying to learn the rules of the road for handling collections.

 

Thanks again!

Edited by PreventativeCare

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A personal check is NOT the same as a bank money order. A money order is considered the same as CASH and triggers the provision quoted in the HIPAA letter.

 

 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

 

A bank money order (NOT a cashiers check) can not be cancelled. 

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Posted (edited)

An additional question I received:
Assuming the amount paid is the same either way (total amount billed), is there any benefit to using the HIPAA method to pay the original creditor versus just paying the collection agency?  They haven't dinged the credit reports. 

 

All of this assumes she just pays (she will), despite that the charge likely should have been covered in full by her insurance if it was billed properly as a preventative care visit expected.  That's what makes this whole experience so irritating.

Edited by PreventativeCare

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If she pays the collection agency directly it may show up on her credit reports as a "paid" collection.

If she wants to be absolutely sure she doesn't get "dinged" on her report and wants to pay in some way that protects her she should pay on line through the OC's website with a debit card (NOT a credit card) and keep a copy of all of the transaction.

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