Teacup9 Posted September 22 Share Posted September 22 $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? Quote Link to comment Share on other sites More sharing options...
CreditSucksNot Posted September 22 Share Posted September 22 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. Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted September 22 Author Share Posted September 22 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. Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted September 22 Author Share Posted September 22 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? Quote Link to comment Share on other sites More sharing options...
Why Chat Posted September 23 Share Posted September 23 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?? Quote Link to comment Share on other sites More sharing options...
CreditSucksNot Posted September 23 Share Posted September 23 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. Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted September 24 Author Share Posted September 24 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. Quote Link to comment Share on other sites More sharing options...
Why Chat Posted September 24 Share Posted September 24 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 Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted October 18 Author Share Posted October 18 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)." Quote Link to comment Share on other sites More sharing options...
CreditSucksNot Posted October 18 Share Posted October 18 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. Bluesie58 1 Quote Link to comment Share on other sites More sharing options...
Why Chat Posted October 18 Share Posted October 18 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 Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted October 19 Author Share Posted October 19 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 Quote Link to comment Share on other sites More sharing options...
Why Chat Posted October 20 Share Posted October 20 "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 Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted November 19 Author Share Posted November 19 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. Quote Link to comment Share on other sites More sharing options...
Why Chat Posted November 22 Share Posted November 22 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. Quote Link to comment Share on other sites More sharing options...
Teacup9 Posted November 23 Author Share Posted November 23 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 Quote Link to comment Share on other sites More sharing options...
Why Chat Posted November 24 Share Posted November 24 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. Quote Link to comment Share on other sites More sharing options...
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