Question
What is the name of your state? NY
In February of 2002, I made my first visit to a medical provider.
Subsequently, I made 3 more visits to this provider in the next two months. The last 3 visits were covered by my health plan, Chickering.
The first visit, apparantly, was not. For this initial visit, the provider billed Aetna, who owns and administers Chickering. According to the hospital that handled the billing, Aetna could not "I.D. the patient" on the claim form, and the bill went unpaid. Apparantly, this unresolved claim went back and forth between the health insurance company and hospital without my knowledge.
Over the period of a year, I received intermittent notification that the subsequent 3 visits were paid. Lab procedures from these 3 visits continued to be billed into 2003 and paid by the health insurance company long after my visits had ended. I was never notified that there was a billing problem with the first visit. The Aetna logo is prominently featured on my insurance card (above "Chickering" which is in smaller font) so this error seems like a case of misleading graphic design.
In June of 2004, I received a call from a collection agency. The hospital had forwarded the unpaid claim to a collection agency. This was the very first time I had heard of this unpaid bill. As I learned the details of this billing error, I was informed to fax my health insurance card over to the collector. They seemed suggest that this would help resolve the problem. I did not hear back from the collection agency.
In late January 2005, I received another call from the collection agency. They claimed that I had promised to pay the outstanding amount in June 2004, which is untrue.
Since then I have tried to collect the pertinent information regarding this unpaid bill. My intention is to cc. the hospital, insurance company and collection agency every correspondence from now until the resolution of this problem. Chickering, the health insurance company suggested they might review this claim, even though it's a very old bill and past their deadline for acceptance (and I am no longer a client with them). However, in order for them to review it, I have to pull together the original claim. The hospital will not administer to any paperwork. They say that once a matter has been sent into collections, the hospital is not allowed to touch it.
The collection agency has been skittish about providing the paperwork. I asked for a copy of the claim, and they sent me their billing sheet for my account instead. It is not a copy of the hospital claim though it does contain some relevant information - diagnosis, description of office visit, procedure code. I checked with the insurance agency and they require the provider's name, address and taxpayer ID on the claim. This information is missing on what the collection agency sent me.
Thus far, neither the hospital, collection agency, nor insurance company are willing to deal with each other directly. None of them are giving much information as to how I might resolve the matter except pay for it myself.
I paid a few thousand dollars a year for this health insurance coverage, and I don't believe I should have to pay for an office visit when it is supposed to be covered by the insurer - especially since the billing error was not made by me.
They left me out of the communication loop during the billing process, and now that there is an outstanding balance, they have finally decided to involve me by threatening my to blacken my credit history. It seems that there is something very wrong about this process. What recourse do I have?
Answer
I was never notified that there was a billing problem with the first visit.
FYI, your insurer must send you a form called "Explanation of Benefits" (EOB) every time a healthcare provider makes a claim on your policy. If you didn't get one, it would have been your responsibility to follow up and do whatever it took to get the bill paid, including paying it yourself if necessary.
They seemed suggest that this would help resolve the problem. I did not hear back from the collection agency.
This should have been done in writing by you, sent by certified mail with return receipt. Now you have no proof you sent it, so you're probably out of luck.
the health insurance company suggested they might review this claim, even though it's a very old bill and past their deadline for acceptance (and I am no longer a client with them).
You no longer being their client does not affect this situation at all. The problem is that they most likely have a timely filing deadline, which has now passed.
However, in order for them to review it, I have to pull together the original claim. The hospital will not administer to any paperwork.
...and they don't need to. This is now a matter between you and your insurer. You just need a copy of your itemized bill from the hospital; you don't need them to administer anything.
They say that once a matter has been sent into collections, the hospital is not allowed to touch it.
That's true.
The collection agency has been skittish about providing the paperwork. I asked for a copy of the claim, and they sent me their billing sheet for my account instead. It is not a copy of the hospital claim though it does contain some relevant information - diagnosis, description of office visit, procedure code. I checked with the insurance agency and they require the provider's name, address and taxpayer ID on the claim. This information is missing on what the collection agency sent me.
...because the collection agency is not the proper entity to be providing you with this document, the hospital is. Surely your insurer has the claim they received from the hospital in their archives.
None of them are giving much information as to how I might resolve the matter except pay for it myself. I paid a few thousand dollars a year for this health insurance coverage, and I don't believe I should have to pay for an office visit when it is supposed to be covered by the insurer - especially since the billing error was not made by me....they have finally decided to involve me by threatening my to blacken my credit history.
1st, PAY THE BILL. Why allow your credit to be adversely affected and continue to rack up late charges and interest? 2nd, file a formal, written complaint with the hospital, stating their billing error has now caused the charges to not be covered by the insurer, and ask them to reimburse you. (by certified mail with return receipt, of course) You might get some results that way.