will fighting an out of network provider motivate them to sue me?

[Teacup9]

$8000+ medical collections from 2020 showing on Experian

 

I sent Experian initial letter.

 

Collection agency responded verifying the debt. Included with the verification is some medical record of the ER visit, including a note that I was notified the provider was out of network and consented to treatment (I do not remember this at all. I was in the ER treated by multiple people and only this provider's bill is an issue.)

 

My Explanation of Benefits shows insurance paid this provider around $600 and my portion is the standard 20% co-insurance.

 

When I spoke to my insurance about the balance billing they said it was not balance billing. They said out of network providers can bill me for amounts over the in network rate. They said exception for treatment in the ER does not apply because the insurance is self funded through the employer (and managed by UHC). 

 

I am concerned that sending the original creditor the letter with option b that this bill is in correct along with the EOB will put me on their radar to sue. Obviously I'd rather the debt sit on my credit report for 3 years than be sued. But is this a rational fear or should I still try to remove it?

[CreditSucksNot]

2 hours ago, Teacup9 said:

When I spoke to my insurance about the balance billing they said it was not balance billing. They said out of network providers can bill me for amounts over the in network rate. They said exception for treatment in the ER does not apply because the insurance is self funded through the employer (and managed by UHC). 

 

Unfortunately accurate. This is my huge issue with self funded plans.  They use a major carrier to provide the processing of claims but it is a self funded plan without the protections of actual insurance in many cases.  

 

2 hours ago, Teacup9 said:

I am concerned that sending the original creditor the letter with option b that this bill is in correct along with the EOB will put me on their radar to sue.

 

If you are still within the SOL for suit for that amount of money it is VERY possible.  With the new law(s) about not reporting medical debts more and more providers are going to move to litigation to get paid.  We haven't begun to see the fallout from this change yet.  

 

2 hours ago, Teacup9 said:

Obviously I'd rather the debt sit on my credit report for 3 years than be sued. But is this a rational fear or should I still try to remove it?

 

If it were me I would lay low.  This isn't a small amount of money and the expense of suing might be worth it to them.  At least wait until the SOL for lawsuit expires but at least 30 days to be sure.

[Teacup9]

Thank you for replying.

 

Yes we have a long list of crap experiences from self funded.

 

SOL for both the debt and credit reporting are 6 years in NJ. We're at 3.

 

Last time we got sued an inexpensive lawyer got it reduced by 50%, but they were asking for about $1000 and it was the co-insurance rate as per the EOB. I am wondering if there is an argument for not billing $8000+ for what UHC pays in network $600. Some sort of fair billing law in effect in NJ in 2020? There are more protective laws in place now but I'm struggling to access 2020 laws.

 

This whole thing has been a frustrating mess. First my EOBs were not available through UHC, they couldn't find them, etc it was a run around. I only got the EOBs by complaining to self funded company HR. Only after I had the EOBs could I get more information out of UHC. They did an inquiry and determined what they paid was final. They also said we're past the time limit to appeal. Seems unfair that I can be sued for up to 6 years, when there is a short time limits on appeals, but that's the systems we live with.

 

If I follow up on my HR complaints they could help or could make sure UHC stays out of it. We've had positive and negative experiences with this route.

 

If I continue to pressure UHC they pay work something out with the original creditor, but they could not and put me on the radar to sue.

 

It is also possible that the standard letters telling the original creditor the bill is incorrect as per the EOB will work because no one will notice the plan is self funded or that the newer laws didn't apply in 2020?

 

I'm going nuts with the gamble. I like to churn credit cards and this $8000 is ruining it. I feel like it will raise our car insurance rate too.

 

[Teacup9]

6 hours ago, CreditSucksNot said:

 

Unfortunately accurate. This is my huge issue with self funded plans.  They use a major carrier to provide the processing of claims but it is a self funded plan without the protections of actual insurance in many cases.  

 

 

Do you happen to know if the provider is able to charge $8000+ for a service UHC pays in network at around $600? Like could I address it that way with some sort of blue book value of claims?

[Why Chat]

Exactly WHAT did you get from the CA in response to your dispute letter??

Did the medical records the CA sent you show an assignment from the OC??

Did it include an assignment of your HIPAA form??

Although the reporting  CA may have obtained the account it may not have been actually transferred from the OC to the CA

You say you sent Experian the "initial" letter?? Was it this one?

https://whychat.me/hipaadisp.html

New Jersey has a 3 year SOL for "open" accounts such as medical/hospital bills

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

If you have not completely followed the guides as yet I suggest you do so:

https://whychat.me/GUIDEBOOK.html

 

Is the account ONLY on Experian??

 

 

[CreditSucksNot]

23 hours ago, Teacup9 said:

Do you happen to know if the provider is able to charge $8000+ for a service UHC pays in network at around $600?

 

YES.  That is the entire point of going "in network."  When you use a provider that is in network they are legally contracted under the plan to only charge what they agreed to when they entered the agreement with the insurer.  That is why they cannot balance bill you for the difference.   They are held by that contract.  When you use a provider that is not in network then there is no contract binding them to what your insurer has in it's agreement with the in network providers.  Since they are not a party to your insurer's plan they can bill what ever they choose and you are obligated to pay that amount not the reduced amount under your plan.

 

 

[Teacup9]

5 hours ago, Why Chat said:

Exactly WHAT did you get from the CA in response to your dispute letter??

Did the medical records the CA sent you show an assignment from the OC??

Did it include an assignment of your HIPAA form??

Although the reporting  CA may have obtained the account it may not have been actually transferred from the OC to the CA

You say you sent Experian the "initial" letter?? Was it this one?

https://whychat.me/hipaadisp.html

New Jersey has a 3 year SOL for "open" accounts such as medical/hospital bills

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

If you have not completely followed the guides as yet I suggest you do so:

https://whychat.me/GUIDEBOOK.html

 

Is the account ONLY on Experian??

 

 

 The CA is SUMMIT COLLECTION SERVIC in NJ. They sent a letter saying enclosed was validation of the debt. a copy of the provider's original bill, the insurance company's Provider Remittance Advice showing the insurance company paid the in-network amount and an asterisk next to "Payer initiated reductions - services not provided by network/primary care providers", and a page of medical records including a note stating the patient requested the service and was told the provider was out of network and asked to proceed anyway.

 

Yes, I sent Experian the initial dispute letter you linked there. Initially Experien sent a letter back saying "We received a recent request regarding your credit information that does not appear to have been sent directly by you or to be authorized by you. As a precautionary measure, we have not taken any action on your alleged request. According to the federal Fair Credit Reporting Act, "if the completeness or accuracy of any item of information contained in a consumer's file at a national consumer credit reporting company is disputed by the consumer and the consumer notifies the company directly of such dispute, the company shall reinvestigate free of charge." Therefore, you can dispute any inaccurate information directly with Experian for free."

 

I ignored their response. Just checked the credit report every week and the 8000 debt was still there.

 

Then I got the validation letter from the collection agency.

 

My plan had been to send the EOB to the OC in the HIPAA LETTER LETTER TO HEALTH CARE PROVIDER with insert b "this bill is incorrect" https://whychat.me/hipltr.html but in the drama it took to obtain my EOB I learned this provider was not in network and allowed to balance bill.

 

I thought NJ law had switched medical to 6 years because I can't find anything confirming 3 years. If it is still 3 years I guess I'll go to this

https://whychat.me/nottoca.html

 

Yes only Experian so far.

 

Sorry for the double posting, I just noticed new threads get responses far more than updates to new ones. I'll stop.

 

 

[Why Chat]

No, send the CA this

https://whychat.me/ltrcavalhipaa.html

READ  this paragraph

This letter is being sent to you in response to your attached letter. ( DO NOT USE THIS SENTENCE IF THE ACCOUNT IS REPORTING AND YOU RECEIVED ANY INVALID RESPONSE FROM THE CA AS A RESULT OF YOUR INITIAL DISPUTE)

If you have nothing in writing use the phrase "recent communication, if you have had NO communication other than the entry on your report, use this:

"This letter is being sent to you in response to your recent fraudulent verification of an unknown medical account on my (name of CRA) report"

Send the remaining body of the letter WITHOUT anything from the first paragraph.

and then send Ex this

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

READ ALL THE INSTRUCTIONS

  

[Teacup9]

On 9/23/2023 at 11:20 PM, Why Chat said:

No, send the CA this

https://whychat.me/ltrcavalhipaa.html

READ  this paragraph

This letter is being sent to you in response to your attached letter. ( DO NOT USE THIS SENTENCE IF THE ACCOUNT IS REPORTING AND YOU RECEIVED ANY INVALID RESPONSE FROM THE CA AS A RESULT OF YOUR INITIAL DISPUTE)

If you have nothing in writing use the phrase "recent communication, if you have had NO communication other than the entry on your report, use this:

"This letter is being sent to you in response to your recent fraudulent verification of an unknown medical account on my (name of CRA) report"

Send the remaining body of the letter WITHOUT anything from the first paragraph.

and then send Ex this

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

READ ALL THE INSTRUCTIONS

  

 

I sent both letters.

 

The CA sent my letter and proof of receipt back to me with the same letter as before saying "enclosed is validation of the debt" and a copy of the dr bill and blew up some doctors notes claiming patient was notified doctor was out of network and agreed to service anyway. No HIPAA, no paperwork showing ownership of the debt.

 

The CRA received my letter this Monday. The CA in collections is still reporting. There are two comments saying "

Account information disputed by consumer (Meets requirement of the Fair Credit Reporting Act)."

[CreditSucksNot]

1 hour ago, Teacup9 said:

No HIPAA, no paperwork showing ownership of the debt.

 

Under the FDCPA they don't have to provide any of that to validate.  It is entirely possible they don't own the debt and are hired by the provider to collect on unpaid accounts.  Many health providers outsource this as it is better financially than employing people just for collections in office/facility.  

[Why Chat]

Have you opted out?? I hope so as otherwise the account may start reporting on TU and Eq

Have you taken the next step in the program?

As soon as you have proof of receipt of the above medical DVs, you send each CRA this:

FOLLOW UP DISPUTE LETTER TO CRAs https://whychat.me/ltrcavalhipaa.html#DISPUTE

Since it is only reporting to Experian you can try this-- (wait a month and recheck your Ex report) 

https://whychat.me/hipaaftccomp.html

 

[Teacup9]

7 hours ago, Why Chat said:

Have you opted out?? I hope so as otherwise the account may start reporting on TU and Eq

Have you taken the next step in the program?

As soon as you have proof of receipt of the above medical DVs, you send each CRA this:

FOLLOW UP DISPUTE LETTER TO CRAs https://whychat.me/ltrcavalhipaa.html#DISPUTE

Since it is only reporting to Experian you can try this-- (wait a month and recheck your Ex report) 

https://whychat.me/hipaaftccomp.html

 

Yes I opted out.

 

Yes I took the next step. The CRA received the re-dispute with the enclosed copy of the validation request and proof of delivery sent to the CA a couple of days ago. I'll wait 30 days and if it doesn't delete I'll try filing the CFPB complaint and send a copy to the CRA. Thank you again.

 

21 hours ago, CreditSucksNot said:

 

Under the FDCPA they don't have to provide any of that to validate.  It is entirely possible they don't own the debt and are hired by the provider to collect on unpaid accounts.  Many health providers outsource this as it is better financially than employing people just for collections in office/facility.  

Then why are all Why Chat's letters asking for the CA to show proof of ownership of the debt and HIPAA agreement to have/view medical records? Why would he confirm those two things again?

 

On 9/23/2023 at 3:23 PM, Why Chat said:

Exactly WHAT did you get from the CA in response to your dispute letter??

Did the medical records the CA sent you show an assignment from the OC??

Did it include an assignment of your HIPAA form??

Although the reporting  CA may have obtained the account it may not have been actually transferred from the OC to the CA

 

[Why Chat]

"Then why are all Why Chat's letters asking for the CA to show proof of ownership of the debt and HIPAA agreement to have/view medical records? Why would he confirm those two things again?"

 

Because if they do not include the requested documentation in their response then it is NOT a "valid" response

[Teacup9]

Experian has responded "outcome remains" "The company that reported the information has certified to Experian that the information is accurate. This item was not changes as a result of our processing of your dispute. "

 

I filed the CFPB complaint. https://whychat.me/hipaaftccomp.html

 

Also of note my health insurance has since sent the original creditor more money, but not the entire amount the collection agency is asking for. My new EOB says that I might owe more because the provider was out of network.

 

I'm not sure where to go from here. It's never been this hard to remove things before.

[Why Chat]

Since the reporting CA has not changed their reporting to reflect the additional amount the OC received from your insurance it is OBVIOUS (to me) that they are NOT and were NOT actually ASSIGNED the account by the OC. When you get a response from the CFPB you can amend your complaint to reflect the additional payment to the OC by your insurance NOT reflected in the CA reporting.

[Teacup9]

You are probably right. But the isurance payment may have come a few days after the last credit report Experian sent and the last "validation" the company set. I think the collection agency already responded to the CFBP? The CFBP emailed that the company was working on it. The CA has sent me the same papers at lease four times, I assumed the most recent one was their response to the CFBP? I'm trying to log in to the CFBP to amend the complaint but they are locking me out and not resetting my password so I will try later.

 

Should I sent the letter to the OC with the EOB even if technically they are out of network and can charge more than the EOB?

https://whychat.me/hipltr.html

 

[Why Chat]

The issue is NOY whether or not the OC was entitled to charge more for being out of network-- the issue is that a CA has obtained your account data ( probably from a data miner as it is not appearing on your other reports).

 

Wait until the CFBP has completed their process before trying anything else.

 

In any case you can't be sued by the CA as they were obviously NOT assigned your account (with the HIPAA release) and the OC has not done anything except accept additional $$ from your insurance-- which leads me to believe their own collection department has been in continuing and current communication with your insurance Co.

[Teacup9]

CFBP has closed the case but I can submit a response before February.

 

Experian and the CA have both sent me back the same paperwork the CA has repeatedly sent as "verification".

 

Experian's response to the CFBP is pasted below. 

 

I can send CFBP the new EOB from insurance showing a larger payment was made (the EOB also states I could owe them more for being out of network), but I'd appreciate any help on the wording or any other ways to respond.

 

Company's Response

Thank you for submitting your dispute on October 19, 2023, through the CFPB Complaint Portal. We appreciate consumers who take the time to let us know about their experiences with our company. We have reviewed and considered the information, including the attachments, you have supplied through the CFPB portal and directly to Experian. You indicate that unauthorized is on your credit report. You are requesting to have the disputed items corrected inaccurate deleted from your report. Per your request to conduct a reinvestigation, we contacted the data furnisher(s) for disputed items on your Experian credit report and asked them to verify the accuracy of the information with which you disagree. They responded and verified that the remaining disputed information was accurate as reported. Other aspects of the disputed item(s) may have also been updated by the data furnisher(s). The results summary was sent to you for review. If you have any additional supporting new documentation regarding the disputed information or any new disputes, you may forward that to Experian for further review. If you disagree with the results of the reinvestigations, it is your legal right, under the FCRA, to add a 100-word statement specifying the nature of your dispute. The consumer statement will appear on your credit report and be viewable upon inquiry. If you would like our assistance in providing a concise statement, please contact us directly at the telephone number or address provided on your personal credit report and we would be happy to assist you. You may refer to the credit report that you received for the name, phone number (if available) and address of the data furnisher or public records office name who verified that information. When you dispute the accuracy or completeness of information on your personal credit report and tell us specifically why you believe the information is inaccurate or incomplete, we process your dispute as required by law. We contact the furnisher of the information or the vendor that collected the information from a public record source such as a court or other government office. We ask the furnisher or the vendor to verify all of the information regarding the item you disputed, and report back within 30 days of the date that we received your request (21 days for Maine residents and 45 days for disputes of information on an annual free credit report). We review and consider the response to determine whether to accept it, reject it, or follow up for additional information. If, after processing, we find that the disputed information is inaccurate, incomplete or cannot be verified, we then delete that information, or modify that information, as appropriate, based upon your dispute and the results of our processing. If we do not receive a response from the furnisher or the vendor within the required period, we update the item as you have requested or delete the information, and send you the results. In some instances, upon reviewing your credit file and any relevant information you have submitted to us, we are able to determine whether the disputed information should be changed or deleted without having to contact the furnisher or the vendor. After we complete our processing, we send you the results. In addition to your right to dispute information in your credit file with the credit reporting agencies, you also have the right to dispute information in your credit report directly with the furnisher of the information. According to the Fair Credit Reporting Act (FCRA), a national consumer credit reporting agency’s role in the dispute process is to review the accuracy and completeness of any disputed item which may include contacting the furnisher of the information or the vendor that collected the information from a public record source, such as a court or other government office, notifying them of the disputed information and disclosing all relevant information regarding the consumer’s dispute. In order to help resolve the consumer’s dispute, Experian will review all relevant documents submitted by the consumer with the dispute and will forward such documents to the furnisher if Experian is unable to resolve the issue based on those documents. Consumers may also contact creditors directly to dispute items reported by the creditor. If the issue is not resolved, then the consumer credit reporting agency must offer to include a consumer statement on the personal credit report. Please note that there is nothing a credit repair company can do for you, including removing inaccurate credit information that you can’t do for yourself for free. We believe it is important to supply you with information about specific credit repair laws. The Credit Repair Organization Act, a federal law, prohibits credit repair companies from taking consumer’s money until they have fully completed the services they promised. It also requires such firms to provide consumers with a written contract stating all the services to be provided and the terms and conditions of payment. Under this law, consumers also have three days to withdraw from the contract. Please contact your local Attorney General’s office for further information regarding your specific state laws. In addition, for more information regarding your credit and frequently asked questions, you may visit: http://www.experian.com/blogs/ask-experian. For additional assistance, you write to Experian at P.O. Box 9701, Allen, TX 75013 or by our document upload service: experian.com/upload. For more information regarding your credit and frequently asked questions, you may visit: http://www.experian.com/blogs/ask-experian. Thank you for submitting your dispute through the CFPB Complaint Portal. It is our policy to respond to consumer complaints swiftly and to take each dispute seriously. We appreciate you letting us know about your experiences with Experian.

[Why Chat]

Sorry that you have been unable to get this removed from your Experian report. However, since it is not reporting elsewhere and you are beyond the SOL for being sued and the reporting CA obviously has obtained your account from some other source than an actual assignment by the OC and Experian is putting the disclaimer on your record-- I would just sit it out and dispute it again (on line or by phone) next year 6 Months after your last response from Experian.

[Teacup9]

Thanks so much for all your help.

 

I see the 3 year SOL on your site, but I can't find confirmation of that for NJ anywhere else. Is it possible it changed? All I can find for NJ medical is 6 years is SOL.

 

No idea what triggered this. My husband's mortgage was sold to another company so maybe they thought we were house shopping but the mortgage isn't on my credit reports and no medical hit his.

 

Meanwhile I can't get a new credit card with this negative on Experian. 

 

It won't help to appeal to the CFBP? Tell them the CA never provided HIPAA nor proof of a current relationship with the OC? Or show that the account doesn't reflect the current EOB?

[Why Chat]

You are correct-- MY BAD!! https://www.solosuit.com/posts/statute-limitations-debt-new-jersey

 

However, the reporting CA in YOUR case has no ability to file any suit as they do not actually have the account assigned to them from the OC.nor do they have any assignment or transfer of your HIPAA release signature.

 

Try this:

https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

 

File a complaint against the CA and Experian for violations of HIPAA