Please help. I don't think I have much time to do something about this.

[HighspeedILMC]

 

I'm just getting started on dealing with a medical bill that I was lied to about from the start and was told I wouldn't have to pay because it was a "preventive" procedure. Then I received a bill after the fact of $1,910. What happened was the doctor sent biopsies to an out-of-network lab without telling me, so that lab billed me. They lied and that's why I didn't pay for it. Now it's been turned over to a collection agency and just showed up on all 3 credit bureaus as an "open account" collection under the collection agency's name.

 

The collection agency is not an in-house collection department of the medical provider. My credit score is over 800, so I do pay all my bills on time and always have. But I refuse to pay this bill. I have good reason to believe the collection agency has violated several FDCPA laws. I could hardly understand the collection agent who called me a few weeks ago. She almost sounded drunk or like she was eating while talking to me. She definitely did not know what she was doing. As unprofessional as you can get. I told her I didn't know who she or her company was and I don't owe them any money. She couldn't even tell me who the original creditor was. I told her to call me back when she figured that out and hung up on her. Never heard back.

 

However, I knew what it was about because I had received a collection letter from them a week or two before that call. I threw it in the trash at that time because I was angry about it, so I have no documentation.

 

From my credit reports today (3/7/2022):

CBV COLLECTIONS INC

Date of first delinquency: 3/29/2021 (2 years ago).

Date given to collection agency: 12/20/2022.

Date reported to the 3 credit bureaus: 2/22/2023.

 

I did some research on CBV COLLECTIONS INC. They are also CBV COLLECTIONS INC dba LIVE OAK FINANCIAL INC. The woman who called me said she was with LIVE OAK FINANCIAL.

CBV COLLECTIONS INC and CBV COLLECTIONS INC dba LIVE OAK FINANCIAL INC have had a total of 22 cases filed against them in the Georgia Middle District Court for violations relating to 15 U.S.C. § 1692 Fair Debt Collection Act; 15 U.S.C. § 1681 Fair Credit Reporting Act; and 28 U.S.C. § 1331,

They've had several BBB complaints as well.

 

I haven't sent any letters to anyone yet and have had no further communications from them. I'm not afraid to go to court, but I need to know what steps to take to shut them down and get this removed from my credit reports on all 3 credit bureaus before it "does" go to court. My credit is stellar and this is the only negative thing on it. I just read Psychdoc's Credit Repair for Beginners document where he describes a lot of stuff to do, but I'm a bit confused on where to start and the correct path to follow here. I can't afford to make any mistakes with this.

 

Thank you in advance for your help. I think I need to act quickly because I have a feeling I might be getting served a court summons soon. I'm more than willing to speak with someone who really knows their stuff about this via any form of communication here, email or phone. (I won't put that contact info in this post as I just joined and I don't know if that's allowed or not).

 

Thank you!

HighspeedILMC

[MarvBear]

Welcome to CreditBoards. 

[Why Chat]

Do you have your EOMBs (explanation of medical benefits) from your insurance for the other medical services you received at the time??

 

Follow the guides:

https://whychat.me/GUIDEBOOK.html

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

 

Send any CRA where the account is reporting this

https://whychat.me/hipaadisp.html

 

Depending on the result of your EOMB search and the result from your dispute you have several options. I doubt very much that you would be served by this scum scam CA as they are NOT the OC (original creditor) health care provider.

 

Come back to THIS POST for further assistance

[HighspeedILMC]

Thank you, Why Chat. I do have the EOB and found the following:

 

I called my insurance company.

They said they paid the pathologist doctor directly $2,200 on a claim he filed in his own name.
He filed the insurance claim on May 21, 2021 and they paid him the full amount of his claim ($2,200) on May 31, 2021.

The same original claim filed by the pathologist showed that my insurance company only approved $290.32 to be paid of the $2,200 amount claimed by him.

The pathologist worked with a group of 3 pathologists dba a company at the time that he filed this insurance claim under his own name.

His company sent me a direct bill in 2021 for $1,910.

$2,200 - $290.32 = $1,909.68 (the amount I was personally billed for by his company in 2021).

I never paid that bill because I was told by my insurance company and the doctor who performed my colonoscopy that the colonoscopy was a "preventative" procedure, therefore there would be no out of pocket costs to me.

The "Remark Codes" section of the pathologist's personal claim filed with my insurance company shows "91 PV".
Remark Code "91" means "Reimbursement of fee schedule and/or contracted rates".
Remark Code "PV" means "Preventative care benefit has been applied".

My insurance company told me that they suspect that the pathologist may have kept the entire $2,200 they paid him for himself and then told the company he works with that he only received $290.32. That prompted his company to engage in "Balance Billing" and send me a bill personally for the difference of $1,909.68. Therefore, this is insurance fraud and double billing.

My insurance company is snail mailing me proof that they paid the pathologist personally in full, $2,200, on May 31, 2021. They said it would take 7 to 10 business days for me to receive it, so it should be here sometime between 3/17/2023 and 3/22/2023. My EOB only shows what was billed, not what was actually paid out.

The problem I'm having is that I'm predicting a court summons any minute now from the collection agency. I don't yet have physical evidence in my hand to show a judge all this. I don't have time to wait for snail mail to get it. I can't afford an attorney. I've called CMS.gov, the Office of Commissioner of Insurance and Safety Fire, the Ga Dept of Law - Consumer Protection Unit. They all keep passing me off to someone else, insist on using snail mail and tell me it will take at least 10 weeks for them to "review" what I send them, etc. I don't have time for all that at this point. I need some kind of investigation started now so it will halt the collection process before I'm summoned to court. If I am summoned to court and just tell all this to the judge without physical proof to show him, I'll lose in court even though the bill has been paid in full 2 years ago by my insurance company. I found that out only yesterday.

[CreditSucksNot]

1 hour ago, HighspeedILMC said:

The problem I'm having is that I'm predicting a court summons any minute now from the collection agency.

 

Calm  down.  There is no need to panic.  Even if you are served tomorrow you have 30 days to answer in GA Magistrate Court or most courts for that matter and it will take another 30 days to get a case on the docket once you answer.  You have enough time to get the necessary paperwork to defend a suit if it happens.  If you are served you wait as long as possible to answer and then if needed get a continuance until you get the proof you sent for.   Most courts will automatically grant a continuance for up to 90 days if needed on the first request.

 

You can also call the billing manager for this collection agency and tell him/her that you have spoken to the insurance company and they show full payment on (date) and you are waiting on that documentation from them.  If you are so inclined you can even let them know that should litigation happen in the face of full payment having been made by your carrier two years ago that a counter claim for negligence, deceptive billing/trade practices, breach of contract and anything else you can legitimately add will be filed in response.  Personally  would start with a nice polite conversation indicating that after speaking to your insurance company they show full payment on a specific date directly to Dr. SoandSo and have they checked with him to see if he forgot to report receiving it to the billing department?  Make them start researching on their end.  

1 hour ago, HighspeedILMC said:

My insurance company told me that they suspect that the pathologist may have kept the entire $2,200 they paid him for himself and then told the company he works with that he only received $290.32. That prompted his company to engage in "Balance Billing" and send me a bill personally for the difference of $1,909.68. Therefore, this is insurance fraud and double billing.

 

To be fair I don't think it is insurance fraud or fraudulent balance billing.  It may be FRAUD though on the part of the pathologist who kept the money and stiffed his business partners.  The good news is if he did this you are not the only patient he did it to and they have been down this road before.  The business itself legitimately believes it has a balance owed because he kept the money or an accounting error.  You are unfortunately stuck in the middle between his possible fraud to his business partners and the business itself.  If I were in this situation my stance would be the insurance paid in full if he failed to remit it to the business they have a fraud claim against HIM but no claim against me.  If they didn't back off of me and drop it, including removing all traces from my credit reports I would be finding the best consumer lawyer in GA and suing their pants off.  

 

Edited to add:  GA does not allow a collection agency to sue on behalf of a creditor so if there is any litigation it would be from the business itself not the CA dunning you.  

Edited March 9, 2023 by CreditSucksNot

[HighspeedILMC]

4 hours ago, CreditSucksNot said:

You can also call the billing manager for this collection agency and tell him/her that you have spoken to the insurance company and they show full payment on (date) and you are waiting on that documentation from them.

@CreditSucksNot Thank you very much for your detailed reply. I called my insurance company again today and found out that the insurance rep I spoke with yesterday was mistaken by saying the $2,200 was paid in full to the pathologist on May 31, 2021. He billed my insurance for that amount, but they only paid him $290.32. So then the pathologist chose to bill me directly for the difference, $1,909.68.

 

I spoke with a lawyer today and found out some very interesting facts about this situation. The pathologist balance billing me directly was illegal at the time according to a Georgia law, GA Code § 33-20E "Surprise Billing Consumer Protection Act" that went into effect on January 1, 2021 (my colonoscopy was performed on March 29, 2021). That law states several things, none of which were adhered to in my case. I was in an in network hospital. They were supposed to have me agree in writing (signature) that I knew and accepted the use of an out of network pathologist. They were supposed to tell me verbally that they were going to use an out of network pathologist. The pathologist was supposed to give me an accurate quote of what he was going to be charging me. None of that happened, They took it upon themselves just to do it without my knowledge or consent.

 

That law also states that the pathologist was only supposed to bill my insurance for the "Contracted Amount" (the going rate) of the amount other in and out of network pathologists charge for the same service in my geographical area. He billed my insurance for $1,909.68 more than he was allowed to, hence they declined that amount. That law says, "In the event a covered person receives a surprise bill for the provision of nonemergency medical services from a nonparticipating medical provider, the nonparticipating provider shall collect or bill the covered person no more than such person's deductible, coinsurance, copayment, or other cost-sharing amount as determined by such person's policy directly...". He massively price gouged.

 

That law states that if the doctor disagrees with the amount the insurance pays him, he must submit a complaint to the Commissioner against the insurance company. Then it goes into arbitration and they all debate how much he should get paid. The arbitrator's decision is final and cannot be appealed. Basically, the doctor and insurance company go to court and fight it out. It does not involve the patient at all.

 

Today, my insurance company said I owe nothing to anyone and they filed a grievance against this pathologist and his group that sent me the bill.

 

This debt is not only invalid, it's illegal. I'm about to draft up some letters to send to this pathologist personally, his group that sent me the bill and to the collection agency they sent it to.

[HighspeedILMC]

I see all kinds of great form letters to send to creditors, collection agencies and the credit reporting bureaus, but I can't find any examples of how to word letters to all these people when the original alleged debt to the original creditor was illegally billed to me to start with. It was in direct violation of Surprise Billing Consumer Protection Act of 2021, GA Code § 33-20E (2021), et seq. and they also broke the law when the collection agency reported this alleged collections debt to all the credit bureaus against GA Code § 33-20E-22 (2021) Reporting to Credit Reporting Agencies. Thank you in advance if you could guide me in the right direction.

[CreditSucksNot]

Before you send any letters out lets consider a couple of more points:

 

20 hours ago, HighspeedILMC said:

The pathologist balance billing me directly was illegal at the time according to a Georgia law, GA Code § 33-20E "Surprise Billing Consumer Protection Act" that went into effect on January 1, 2021 (my colonoscopy was performed on March 29, 2021).

 

When the law changes it can take 6 months to a year for providers to catch up to all the changes and intricacies.  That said, they have had more than enough time to undo the mistake and haven't.  My point is it might not have been malicious at first but merely over site.  It becomes wrong when they don't fix it when they know they are wrong.

20 hours ago, HighspeedILMC said:

They were supposed to have me agree in writing (signature) that I knew and accepted the use of an out of network pathologist.

 

Get copies of EVERYTHING you signed that day.  Most patients don't read what they sign merely scribbling their signature knowing they will be billed and move on to the procedure.  You don't want to find out that in the consent form(s) and financial agreement it stated they were using an OON pathologist.  If there is nothing in there about that THEN you can add that to your letter(s).

21 hours ago, HighspeedILMC said:

They were supposed to tell me verbally that they were going to use an out of network pathologist.

 

There is another possibility:  they DID tell you but you don't remember.  A colonoscopy involves sedation.  DEEP sedation using 2 drugs:  Propofol and Versed.  Both of these drugs have an amnesia component and that is why anesthesia uses them so that patient's don't have memory of the procedure or fear before surgery.  I am not saying you aren't right on their billing but do not rule out that your signed the forms they DID explain this to you and you don't remember because anesthesia did a great job.  I explain to my patient's spouse or family member things I need them to remember about what I do and that I do this because when anesthesia does a great job the patient themselves won't remember any of what we are discussing.  Many don't ever meeting me despite 5 pages of paperwork we go over and a 15 minute or more conversation.

21 hours ago, HighspeedILMC said:

That law also states that the pathologist was only supposed to bill my insurance for the "Contracted Amount" (the going rate) of the amount other in and out of network pathologists charge for the same service in my geographical area. He billed my insurance for $1,909.68 more than he was allowed to, hence they declined that amount.

 

That isn't how billing works.  A non-covered provider would have no way of knowing how much your contracted amount is for an in-network provider.  They are not part of the contract.  Even a contract provider can bill what ever they want to insurance but they won't get paid more than the contractual amount.  That is why your EOB shows a billed amount, contracted amount, what they paid and what you OWE.  What is illegal is the balance billing of the amount in difference between what is billed and what is paid.  I suspect that the law is being misquoted or interpreted by someone as to not being able to bill more than the contracted amount to the carrier.  It is correct they cannot bill you the difference.

21 hours ago, HighspeedILMC said:

Today, my insurance company said I owe nothing to anyone and they filed a grievance against this pathologist and his group that sent me the bill.

 

I am happy to hear they are backing you up and not leaving you hanging to deal with it on your own.

21 hours ago, HighspeedILMC said:

This debt is not only invalid, it's illegal. I'm about to draft up some letters to send to this pathologist personally, his group that sent me the bill and to the collection agency they sent it to.

 

When you draft a letter to the CA remember more than likely they are simply relying on the information the pathology business gives them.  They have no way of knowing your contracted amount or what the EOB said.  Just as the bureau relied on what the CA said when they reported it.  They don't have any of the information that led to the reporting they rely that it is accurate but really aren't that great of doing much when it isn't.  My approach would be stern but objective.  i.e. that given the Surprise Billing Act they now have a burden to ensure that they are not illegally balance billing (quote the GA law code here) and that the providers they contract with to collect for are not circumventing the law to illegally balance bill either.  Then demand they remove the trade line immediately and cease collection efforts as there is no bill due.

19 hours ago, HighspeedILMC said:

I see all kinds of great form letters to send to creditors, collection agencies and the credit reporting bureaus, but I can't find any examples of how to word letters to all these people when the original alleged debt to the original creditor was illegally billed to me to start with.

 

NEVER ever use form letters for a situation like this.  It calls for a personalized letter that is emotion free and direct and to the point.  You need the facts, straight and simple along with the appropriate state and federal law does quoted to back up your complaint at the appropriate time.  You have every right to be angry but you will get more accomplished if you don't go rogue "Karen" on them and be direct and tell them exactly what resolution you expect from them.  Form letters get ignored.  Well crafted personalized letters get attention and action.

[HighspeedILMC]

@CreditSucksNot Thank you very much for the time you took to give me such a well thought out and detailed response. I've spent several days, more than a week, from the time I wake up until the time I go to bed researching this and how to properly handle it. Right this minute I have 45 tabs open in my web browser. So frustrating when this shouldn't even be happening.

 

I decided this morning to start out with Whychat's FORM LETTER TO ORIGINAL HEALTH CARE PROVIDER at https://whychat.me/hipltr.html , but I'm heavily modifying it to personalize it to this given situation. I'm not going full on "Karen" on them, but I am very clearly and sternly pointing out how they broke the law back then and continue to do so today. I am including the fact that they never even spoke with me, never had my oral or written consent and never gave me any kind of estimate of potential charges from them according the Georgia law that was in effect at that time and even still today. I am going to tell them that I expect them to immediately void this "debt", remove their CA from it and remove the collections tradeline from all credit reporting agencies. I'm also going to tell them that if they don't, I intend to take every legal recourse available to me that would force them to do so. I'm going to demand that they send me their actions or intended actions in writing. I suppose you could call that somewhat "Karen", but I have zero patience or sympathy for anyone who attacks me, my money or my family's well-being or peace of mind. Right is right and wrong is wrong. I've been losing sleep over this. I almost went to pay them a personal visit this morning, but a cop friend of mine talked me out of it. I'm glad he did!

[Why Chat]

You are proceeding correctly given the excellent data that has been provided here-- BUT, I suggest you start with a simple letter to the CRAs to see if you can get this deleted BEFORE you engage the "heavy guns". There is a very real possibility (IMO probability) that the reporting CA did NOT obtain your account directly from the OC but picked it up from a data miner, in which case they would have NO standing to file ANYTHING.

https://whychat.me/GUIDEBOOK.html

https://whychat.me/hipaadisp.html

 

 

 

[HighspeedILMC]

@Why Chat Thank you for your reply. This has become much bigger than just me trying to get a fraudulent report removed from my credit report. I'm a former corporate investigator/skip-tracer for a law firm. I can't go into details, but you will eventually be hearing about this.

[HighspeedILMC]

@Why Chat Would you please explain to me how CA's use data miners to obtain accounts to initiate collections actions on? I've been in the IT field for 40 years, so I'm very tech savvy. I just need a clear understanding, hopefully with an example, of the process start to finish on how the CA's data mine to obtain their collection accounts. Also, is this practice illegal and, if so, can you point me to the law that says it's illegal? Thank you in advance.

Edited March 19, 2023 by HighspeedILMC

[Why Chat]

There is nothing illegal (to the best of my knowledge) for CRAs to sell their account data. Most account data is sold to companies who wish to offer you credit. There is nothing illegal (to the best of my knowledge) for data mining companies to purchase account data from CRAs. (This is why I recommend opting out) Opting out prohibits the CRAs from selling your data or transmitting it to anyone other than an entity YOU have given permission to.

 

Surely you have seen on various documents that YOUR signed release is required for someone to access your credit report information.

 

Once a data miner has acquired your data from the CRAs they are free to sell it to whomever wishes to purchase it. Here we get into murkier legal waters as SOME CAs specialize in dredging up discarded written off balances from medical accounts and "matching" them to the acquired credit data.  

[HighspeedILMC]

5 hours ago, Why Chat said:

CAs specialize in dredging up discarded written off balances from medical accounts

@Why Chat Do you know how the CA's do this? I know that the CRA's have a subscription service just for CA's that notify them as soon as a consumer's credit report changes (ie applying for a loan, opening a new tradeline, etc). That's a clear sign to start collections actions again or ramp it up more. But how do the CA's get discarded medical accounts?

[legaleagle2012]

My insurance company is snail mailing me proof that they paid the pathologist personally in full, $2,200, on May 31, 2021. 

 

This is key to having this thrown out. I would suggest an attorney for this, if this involves violtions of the law as you claim. You can probably win this easily and get legal fees and maybe punitive damages for the billing practices. The rest (fraud etc) is probably between the insurance company and the doctor.

 

[Why Chat]

On 3/19/2023 at 9:14 PM, HighspeedILMC said:

@Why Chat Do you know how the CA's do this? I know that the CRA's have a subscription service just for CA's that notify them as soon as a consumer's credit report changes (ie applying for a loan, opening a new tradeline, etc). That's a clear sign to start collections actions again or ramp it up more. But how do the CA's get discarded medical accounts?

If as you say you are knowledgeable about computer searches (a skip tracer would have to be) unless your experience was in the not too distant past where people had to look things up in phone directories, it is a very simple process to acquire "data dumps" from all kinds of sources, especially billing departments of doctors that have not updated their data protection. 

[HighspeedILMC]

On 3/22/2023 at 7:15 PM, Why Chat said:

it is a very simple process to acquire "data dumps" from all kinds of sources

@Why Chat Sorry it's taken a while to get back to you. This investigation has been intense and very time consuming. What you said about data dumps is true, but irrelevant upon discovery of new information. I'm unable to discuss what's going on at the present time, but I'll let you know as soon as I'm able. That's if you don't hear about it elsewhere first.