Balance Bill Dispute Now in Collections

[feelyat]

TL;DR story: Early last year, I was looking for treatment by a particular clinic that specialized in my medical needs. According to my insurance company, the clinic was in-network, so I went. The clinic wanted some basic bloodwork done before they would prescribe the medications I needed, so they sent me down the hall to the "hospital" facility to have blood drawn. That bood draw facility was apparently out of network for me. They billed my insurance company, who told me that their allowable cost for that service was about $150, but because it was out of network, they weren't covering it. The hospital proceeded to bill me over $1700 for that same service. No warning, no up-front estimate. Just a big bill.

 

To me, this is classic balance billing, seems patently unfair, and should be disallowed by the "no surprises" act (https://www.cms.gov/medical-bill-rights), so I disputed it with the hospital. I quoted the requirements of the act (good faith estimates, required consent for any charges), and tried to work it out with the provider. They wouldn't budge (though they admitted fault), so I filed a federal complaint against them.

 

Now, they have moved this account to collections, and I got my initial letter from the CA. I'm considering disputing it as a normal collection, but I also wonder if there are any special circumstances because this is an unresolved dispute with the original provider about their billing practices. I don't want to pay them; it's a matter of principle.

[Why Chat]

You are in the right-- however you should still take some pro-active steps to safeguard your credit.

 

Follow the guide

https://whychat.me/GUIDEBOOK.html

 

Opting out will help prevent your credit data being SOLD to data miners while your case(s) are pending.

 

I suggest you take stronger pro-active steps than a simple dispute letter.

https://whychat.me/ltrcavalhipaa.html

 

You can use the appropriate phrases as they certainly apply to your situation 

[feelyat]

Thanks.

 

That guidebook is a little hard to follow (always has been -- that's part of its charm), but it also doesn't really address my situation. It appears to be mainly focused on getting deletions and stopping reporting from CAs for medical debt that has been paid. In my case, I don't think that the original debt reported is valid, and my main dispute is with the provider.

[StarkRaven$]

14 hours ago, feelyat said:

Thanks.

 

That guidebook is a little hard to follow (always has been -- that's part of its charm), but it also doesn't really address my situation. It appears to be mainly focused on getting deletions and stopping reporting from CAs for medical debt that has been paid. In my case, I don't think that the original debt reported is valid, and my main dispute is with the provider.

Good point feelyat. I hope you prevail. These practices are maddening for the consumer. Their paperwork is especially confusing too so I personally don't buy into the narrative that the consumer didn't read the paperwork and should be held responsible. 

[Why Chat]

23 hours ago, feelyat said:

Thanks.

 

That guidebook is a little hard to follow (always has been -- that's part of its charm), but it also doesn't really address my situation. It appears to be mainly focused on getting deletions and stopping reporting from CAs for medical debt that has been paid. In my case, I don't think that the original debt reported is valid, and my main dispute is with the provider.

The only part of the guidebook I suggest you follow is to opt out and use the dispute letter  https://whychat.me/ltrcavalhipaa.html  to respond to the CA.  It contains language that would be  probative if you get to the point of filing any complaints against them IF they continue ANY collection activities including reporting. Here is the link to file a complaint against either the CA, the OC or any CRA or all 3.  https://whychat.me/hipaaftccomp.html

[CreditSucksNot]

On 9/1/2024 at 6:54 AM, feelyat said:

They billed my insurance company, who told me that their allowable cost for that service was about $150, but because it was out of network, they weren't covering it. The hospital proceeded to bill me over $1700 for that same service. No warning, no up-front estimate. Just a big bill.

 

You already had the blood drawn.  They can't give a warning for what your insurance will do unless you wait to do the draw and get a pre-authorization first.  Same for the estimate.  If the needed care isn't an emergency it is always best to call your insurance company FIRST and find out if they are in network and if the care is covered.  THEN the hospital can give an estimate when the pre-authorization is done.

On 9/1/2024 at 6:54 AM, feelyat said:

To me, this is classic balance billing, seems patently unfair, and should be disallowed by the "no surprises" act

 

This is NOT illegal balance billing.  Illegal balance billing is when the provider bills $750 for a service and your insurance contract states your out of pocket owed to them is $250 but they try and bill you for the remaiing $500 in violation of the contract.  When you go out of network for non-emergency care all bets are off.  It shouldn't be a surprise as this is the standard on out of network care that you or the insured holding the policy is responsible for all charges at an out of network facility until you meet the OON deductible.  The insured is always responsible for knowing the terms of their coverage for elective/non-emergency care.  

 

On 9/1/2024 at 6:54 AM, feelyat said:

I quoted the requirements of the act (good faith estimates, required consent for any charges), and tried to work it out with the provider.

I guarantee you that you DID consent to the billing.  Before they ever drew one drop of blood they had you sign paperwork in the admissions office or the lab itself and one of them was a financial responsibility agreement.  In that document is a paragraph that specifically states they bill your insurance coverage as a courtesy but if the claim is denied or not covered you are still responsible for the charges.  Since that provider is out of network they are not bound by a contract limiting what they can charge for the care you already received prior to the bill.  They can't even offer a discount or charity care because you are insured and that would be illegal rebating.

On 9/1/2024 at 6:54 AM, feelyat said:

Now, they have moved this account to collections, and I got my initial letter from the CA. I'm considering disputing it as a normal collection, but I also wonder if there are any special circumstances because this is an unresolved dispute with the original provider about their billing practices.

From a credit perspective:  no there are not any special circumstances that you can leverage in this situation.

On 9/1/2024 at 6:54 AM, feelyat said:

I don't want to pay them; it's a matter of principle.

You are certainly entitled to hold to your principles but if you value your credit you will reconsider doing so.  The amount in dispute is 3x the amount they can report and in this day and age may hospitals are going right to suing when a few months of collection letters yield nothing.  I would check your court docket locally and find out if this hospital is one of those before you decide to stand your ground on principle because that isn't a defense to a lawsuit or credit reporting.

[feelyat]

 

59 minutes ago, CreditSucksNot said:

When you go out of network for non-emergency care all bets are off.

 

Uh...and you're OK with that? So if I get a band-aid at an out-of-network facility, you're OK with them charging me $5k because that's my OON deductible?

 

This was not a case where I had a lot of choice. The doctor I saw was in-network, but the hospital their office was part of was out-of-network and had the same name and address as an in-network facility (I checked beforehand). 

 

1 hour ago, CreditSucksNot said:

Before they ever drew one drop of blood they had you sign paperwork in the admissions office or the lab itself and one of them was a financial responsibility agreement.  In that document is a paragraph that specifically states they bill your insurance coverage as a courtesy but if the claim is denied or not covered you are still responsible for the charges.

I'm fine with that, as long as they can tell me, up front, what those charges will be, or if they align with expectations for other similar services. Even double my in-network costs would be in the realm of possibility, but a 1000% mark-up seems to be taking advantage of the un- and under-insured. 

 

I know, I'm not a lawyer or a hospital administrator, and I am taking the unusual position of expecting reasonableness on this topic from those who are.

[CreditSucksNot]

2 hours ago, feelyat said:

Uh...and you're OK with that? So if I get a band-aid at an out-of-network facility, you're OK with them charging me $5k because that's my OON deductible?

 

I said it is legal and isn't balance chasing. It isn't a matter of being okay with it.  It is basic contract law.  The lab has no contract with your insurer and therefore has no contractual/legal obligation to offer you discounted pricing.  Had you known they were out of network and still wanted the blood drawn right then the next question to reduce the financial cost is "what is the cash pay price"?  Most providers off a HUGE discount if you pay for the service up front.  I often ask what the cash pay price is because it can sometimes be less expensive than my insurance out of pocket.  Your policy clearly explains what out of network care can cost you.   When you go out of network even the least saavy consumer knows there are financial consequences.  You are all emotional about it because essentially you cost yourself money and now you want to blame everyone else. 

 

2 hours ago, feelyat said:

This was not a case where I had a lot of choice. The doctor I saw was in-network, but the hospital their office was part of was out-of-network

 

You very much had a LOT of choice.  You ASSUMED because they shared space and a similar name it was in network.  You NEVER assume.  First you could have asked the provider ordering the blood tests if the facility was in network.  They should know and if they didn't you call your insurer before you head up the hallway and have it drawn.  Your insurer would have told you right then the facility was not covered.  Was it convenient to just do it immediately?  Of course.  Was it financially a good move?  Not at all.  You did what a LOT of patients do.  You said "no problem doc" and then trotted on down the corridor and signed forms you didn't read and now have a large bill because the facility wasn't in network.  You didn't ask any questions until you got billed.  These are YOUR decisions to make when it isn't a medical emergency and you are expected to know and understand your benefits.  The providers can't do it all for you but you didn't even ask them if the lab was covered.  You didn't ask the lab if they were in network.  You consented and got billed.  End of story.  

 

My family practice doctor has a branch of a large national lab in their office.  I changed insurance plans last year and that lab is not covered at all.  When he ordered annual blood work the first thing HE said was it isn't in network you have to go to [competitor] lab and have it done.  Wasn't what I wanted to hear as their locations are spread out and a pain to use but paying $37 for all my labs out of pocket vs. over $1500 going out of network was worth waiting and the minor inconvenience. 

 

2 hours ago, feelyat said:

I'm fine with that, as long as they can tell me, up front, what those charges will be

 

The drone clerk at the window has NO idea what those charges will be.  If you are lucky they MIGHT know their facility isn't in network but with the vast number of plans they probably don't.  Did you ask the person registering you if they were in your network or what the charges will be?

2 hours ago, feelyat said:

Even double my in-network costs would be in the realm of possibility, but a 1000% mark-up seems to be taking advantage of the un- and under-insured. 

Well DUH.  You act like this is new information.  Charging everyone else to cover those who can't or don't pay isn't new.  Where do you think that money for the charity care fund major hospitals has comes from?  There is no such thing as government paying for anything.  That comes from the tax payers pockets.  

2 hours ago, feelyat said:

I know, I'm not a lawyer or a hospital administrator, and I am taking the unusual position of expecting reasonableness on this topic from those who are.

I am not a lawyer or hospital administrator either but their job(s) are not to protect you from your own bad choices in your health care.  Reasonableness is a subjective term.  What you really want is someone to tell you what you want to hear which is that you can continue to refuse to pay the bill and it won't affect your credit.  Well, legally you are responsible and it could affect your credit if you don't.  No pun intended but it is a bitter pill to swallow on the back end of medical care like this when you realize that you could have saved a lot of money had you just knew your policy requirements and asked a couple of questions instead of  blindly signing a consent form to have blood drawn and a financial guarantee you never read.  Calling me unreasonable for explaining how medical billing works and why your soap box protest won't protect your credit doesn't change the reality of the situation.  It doesn't matter whether you agree or you like it.  Your insurance is a contract between you and the insurer and the carrier and the providers.  If you intend to use the coverage then there is a responsibility you accept to understand the basics of the policy of what is covered and what isn't and at what cost.  You can learn from this or keep pouting.  The choice is yours.

[feelyat]

OK, let's take a step back from the preaching and blaming here. For whatever reason, I have a dispute with the provider. You seem hell-bent on telling me that my dispute will fail because of my bad life choices. Thanks for that, I guess. Regardless, what I wanted to know is, if I have an ongoing dispute about a medical bill with a provider, and the provider has initiated collections against me, can I use the dispute letter language from WhyChat's guide to gain some advantage with the CA? I think that has been answered in the affirmative, so I'm going to give it a shot. It really can't hurt.

 

Again, thanks for your input.

[Why Chat]

I forgot to ask you what State you are in. Many States have enacted statutes prohibiting overcharging on "surprise" billing. Here is Florida's 

https://www.hss.edu/no-surprises-act-fl.asp