Seeking Help Dealing With Collections

[Matt46]

I  am seeking advice on my options for dealing with a collections agency. 

I received a bill dated April 3,2023 from Credence Resource Management for $1,800 for an account with American Medical Response. This is for an ambulance charge when my 12-year-old son had his first seizure and went to the ER. I never received this bill and the charges were not submitted to our insurance, which would have covered the charges. All the other myriad charges from that day (ER, CT scan etc.) were submitted and covered. In fact, I paid another bill to American Medical Response the following year for another ambulance service for my son and was never told of any outstanding charges on our account.

I sent a certified letter to Credence requesting proof of this debt that was received on April 17 by Credence. Today, May 27, I received a letter from Credence (dated May 18) confirming receipt of my request to verify the debt along with the original bill from American Medical Response--which is from 12/04/2021.

I have confirmed with my insurance that they never received this bill and I believe they said it can not be resubmitted because too much time has past.

Am I stuck paying the full amount for this? Did Credence respond to my request for verification soon enough? Can this amount be submitted to my insurance company? Should I attempted to negotiate this debt down directly with Credence? Any advice would be greatly appreciated.

[MarvBear]

Welcome to CreditBoards. 

[CreditSucksNot]

8 hours ago, Matt46 said:

Am I stuck paying the full amount for this? Did Credence respond to my request for verification soon enough? Can this amount be submitted to my insurance company? Should I attempted to negotiate this debt down directly with Credence? Any advice would be greatly appreciated.

 

One method of disputing the amount you owe when the provider did not send you a bill or submit a claim themselves is to find out from your provider what the contracted amount is/was on the service.  You can then make an offer to settle based on the contracted amount they were legally entilted to under your plan.  I would ask why they didn't submit a claim or send a bill.  Verify they sent it to your current and accurate address at the time of service.  Informing them that all other providers claims for that date of service were paid timely except theirs because they took an unreasonable amount of time to notify you of their bill.  Verify if they did submit a claim that it was to the correct insurance policy.

 

I had a similar incident with an anesthesia provider.  Suddenly was in collections when every other provider had been paid on the surgery.  When I contacted them discovered they had submitted a claim but have NO idea whose insurance it was.  Once they got the correct policy information in their system turns out I didn't owe the $980 they claimed.  I owed $35.  

[Why Chat]

Opt out and get your current credit reports;

https://whychat.me/GUIDEBOOK.html

I suggest you send Credence the following (with a copy to your insurance Co.)

 

(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.
It was not properly transmitted in a timely manner to my insurance company.( Documentation of late submittal from insurance attached)

The time limit for billing or collection of a medical account in (name of your State) has elapsed and any further billing or demand will be reported to the proper authorities.
 
Please be advised that under Federal Statutes. the Fair Credit Reporting Act, (15 U.S.C. § 1681 et seq) you may be held liable for any of your actions or actions of any collection agency you may assign the account to. Therefore I am requesting you promptly delete all such account information that has been or may be furnished to any collection agency and  purge all records of any reference to this account, and that you insure that any and all reporting of this account is prohibited from being reported to my credit reports.

 

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)

 

[Matt46]

Thank you for the responses. What are the chances they sue me if I opt out and send the above letter? I'm not sure if the following is true in California: "The time limit for billing or collection of a medical account in (name of your State) has elapsed and any further billing or demand will be reported to the proper authorities."

[Why Chat]

 

https://www.dir.ca.gov/dwc/ebilling/StandardizePaperBilling_FAQs.html#:~:text=Q%3A Is there a time,in the California Labor Code.

 

 

Q: Is there a time limit to submit a medical bill?

A: Yes. There are different time requirements for submitting a bill (12 months, 180 days, or 30 days) depending on the type of service and other factors as set forth in the California Labor Code.

For services rendered, or inpatient discharges, on or after January 1, 2017, there is a statutory requirement that medical bills be submitted within 12 months of the date of service, or within 12 months of the date of discharge for an inpatient bill. (California Labor Code section 4603.2.)

n California, medical providers must submit claims for payment within one year of the date of service for the treatment you received. After that, the provider cannot bill you for that service. However, there are some exceptions to this rule, such as if the provider has a contract with the insurance company that allows for a longer time frame to submit claims, or if there is an ongoing dispute about the services provided. If you are concerned about a medical bill you have received, it's important to review it carefully and reach out to the provider or your insurance company for clarification.

 

[Matt46]

The ambulance company says they sent me a bill, and Credence sent me the bill (upon my request of verification) I was supposedly sent which is dated within the time frame.  I guess it was either ost in the mail or stolen. However, the ambulance company NEVER submitted the bill to insurance. They told me when I called them after receiving bill from collections that we never provided them with the insurance info. My wife 100% did do this on the ambulance ride and we paid a subsequent bill from the same company for the same son the following year when we got the bill and were never told of any outstanding balance for my son's account etc. Would you still send the above letter under these circumstances?

[Matt46]

Just want to confirm that just my health insurance co. goes in the portion of the letter:

 

HIPAA Compliance Office
( health care provider creditor)
(address)
(date)

 

Thank you.

[Matt46]

And sorry for the repeat question but are they still not in compliance with California code if the ambulance company said they sent me the bill within the proper timeframe (though I never received it) but did not submit it to my insurance company?

[Why Chat]

Quote

 

Just want to confirm that just my health insurance co. goes in the portion of the letter:

 

HIPAA Compliance Office
( health care provider creditor) NAME OF AMBULANCE SERVICE

 

No, this should be addressed EXACTLY as shown it is intended to be sent to the ambulance service's HIPAA compliance office, 

I suggest that you include in your letter to them this:

It was not properly transmitted in a timely manner to my insurance company.( Documentation of late submittal from insurance attached)

Plus my records with your service shows other billings were properly transmitted to my insurance which records you SHOULD have had on file (attached other paid billing)

The time limit for billing or collection of a medical account in (name of your State) has elapsed and any further billing or demand will be reported to the proper authorities.

[Matt46]

Really appreciate your attention to this and help. I think I need to review the whole HIPAA process as I am a bit confused. Who exactly is supposed to respond to me within 10 days with confirmation of the below (HIPAA or Credence?): 

"Therefore I am requesting you promptly delete all such account information that has been or may be furnished to any collection agency and  purge all records of any reference to this account, and that you insure that any and all reporting of this account is prohibited from being reported to my credit reports."

 

I apologize for my ignorance on this matter and the repeat questions.

 

[MarvBear]

@Matt46  If you follow Why Chat's instructions to a "T" then the respondent would be the entity to whom you had addressed your letter based on the instructions from Why Chat.

[Matt46]

Ok. Thanks. I see both:

 

"I suggest you send Credence the following (with a copy to your insurance Co.)" (Credence is collections)

 

and

 

"No, this should be addressed EXACTLY as shown it is intended to be sent to the ambulance service's HIPAA compliance office" 

 

[Matt46]

American Medical Response did not have contact info for HIPAA Compliance Office. Should I just use the contact address listed on the bill to remit payment to?

[Matt46]

Also, I sent my first letter to Credence certified and they received it. Is it ok to send this letter to them certified?

[Why Chat]

I am getting confused-- what stage of the HIPAA letter program are you in??

 

You opted out?

 

You sent them (Credence) the letter certified mail?? You were supposed to send it to the health care provider !! MY BAD I thought Credence was the name of the ambulance service!! 

 

Yes send the letter to your health care provider (the ambulance service) Use the address on any billing from THEM att: HIPAA compliance office

[Matt46]

Oh no. I also sent it to Credence in addition to the ambulance company. Is that bad?

[Matt46]

Should I attempt to stop delivery on the letter to Credence?

[Matt46]

I stopped delivery of letter to Credence. It is just going to the health care provider. 

[Why Chat]

OK--sorry for the confusion glad you caught my mistake in time.

[legaleagle2012]

That statute you cited  is for worker's comp, I doubt it applies to your situation. This one might help.

 

https://codes.findlaw.com/ca/insurance-code/ins-sect-10133-66/#:~:text=(a) Deadlines shall not be,providers after the date of

 

 A health insurer that denies a claim because it was filed beyond the claim filing deadline shall, upon provider's demonstration of good cause for the delay, accept and adjudicate the claim according to Section 10123.13 or 10123.147, whichever is applicable.

[Matt46]

4 hours ago, legaleagle2012 said:

That statute you cited  is for worker's comp, I doubt it applies to your situation. This one might help.

 

https://codes.findlaw.com/ca/insurance-code/ins-sect-10133-66/#:~:text=(a) Deadlines shall not be,providers after the date of

 

 A health insurer that denies a claim because it was filed beyond the claim filing deadline shall, upon provider's demonstration of good cause for the delay, accept and adjudicate the claim according to Section 10123.13 or 10123.147, whichever is applicable.

Thank you. I did send the letter WhyChat recommended above. Do you anticipate an unfavorable outcome? I'm still unclear on how I am protected against the provider simply insisting that they sent me the bill directly and it was my responsibility to submit it to insurance. I did include this portion in my letter: "my records with your service shows other billings were properly transmitted to my insurance which records you SHOULD have had on file" and included a copy of EOB from insurance company showing that the ambulance company did properly submit a claim for my same child the following year. Of course I paid the patience balance owed in full when the medical company subsequently sent me the bill (once again, there was no notification at all about balance due from previous year).

[Why Chat]

https://blog.daisybill.com/timely-billing-coming-to-california

 

SB 1175, Section 1

Amends Labor Code 4603. Effective January 1, 2017

 

• Within 12 months of rendering a service, the provider must submit the bill for services.
• Physicians, Hospitals, Pharmacies, interpreters, Copy Services, Transportation Services and Home Health Care Services are among the types of providers impacted by this Labor Code.
• No payment is due for untimely bill submission.
• This requirement does not apply to dates of service prior to January 1, 2017.

[Matt46]

I sent the letter to the ambulance service certified and I notice that the status on USPS is in limbo. It was supposed to have arrived Monday but it is just showing as the following and hasn't been updated since June 6. Is this because it is a PO Box? Do I need to resend it priority mail?

Latest Update

Your package will arrive later than expected, but is still on its way. It is currently in transit to the next facility.

 

[TurdFerguson1]

On 5/28/2023 at 1:50 AM, Matt46 said:

I  am seeking advice on my options for dealing with a collections agency. 

I received a bill dated April 3,2023 from Credence Resource Management for $1,800 for an account with American Medical Response. This is for an ambulance charge when my 12-year-old son had his first seizure and went to the ER. I never received this bill and the charges were not submitted to our insurance, which would have covered the charges. All the other myriad charges from that day (ER, CT scan etc.) were submitted and covered. In fact, I paid another bill to American Medical Response the following year for another ambulance service for my son and was never told of any outstanding charges on our account.

I sent a certified letter to Credence requesting proof of this debt that was received on April 17 by Credence. Today, May 27, I received a letter from Credence (dated May 18) confirming receipt of my request to verify the debt along with the original bill from American Medical Response--which is from 12/04/2021.

I have confirmed with my insurance that they never received this bill and I believe they said it can not be resubmitted because too much time has past.

Am I stuck paying the full amount for this? Did Credence respond to my request for verification soon enough? Can this amount be submitted to my insurance company? Should I attempted to negotiate this debt down directly with Credence? Any advice would be greatly appreciated.

I may be late to the party here but…..I’ve got a buddy that just had a medical collection come to him. He owed it, but he found out that  the tricky thing with medical collections is the red tape due to HIPAA. In order to collect on a debt, a debt collector must have the original contract bearing the debtors signature for the debt to be contractually binding. If no HIPAA Authorization form was signed by the patient to release this, then there is no original contract. I’m guessing they only sent you dates, times, procedures, costs minus insurance and copays? 
 

My friend wrote a letter and worded it like this:

 

I have just received two collection letters from your company. One in the amount of $xxx and the other in the amount of $xxx.  Reference number XXXXXXXX .  I formally deny any responsibility of this debt.  Perhaps you have entered it in error as I see that you are not the original creditor or owner of the account.  I hereby demand that you validate and conduct a full proper investigation into this debt or delete it. 

To be clear, I have the right to have this debt validated, as I believe you are reporting this account in error.  As I see that this is a medical collection, please provide me with the date of the alleged medical service(s), the medical provider, and the name of the patient and any contractual obligation which binds me to this medical debt.  Furthermore, I am also requesting an agreement that bears the signature of the alleged debtor where he or she signed an authorization form for HIPAA.

 

ACCOUNT: (In this case it would be Credence Resource Management with the reference number)

 

If you cannot present what I request, I demand that you cease and desist on your erroneous attempted collection and refrain from reporting this account to the credit bureaus to avoid violating section 623a (1)A: reporting information with actual knowledge of errors.

Please respond in writing within 30 days so we can resolve this matter without any more violations.

Thank you.

 

If they respond to that and don’t provide you with the original contract bearing your signature or the HIPAA Authorization form that you demanded(they won’t), then file a claim with the Consumer Financial Protection Bureau. 
 

My buddy did this, and he got a resolution in under 24 hours from the collection agency and was informed that the account was put in a “ceased status” and that “there will be no further contact from XXXXX or the law firm XXXXXXX.