Question
FLORIDA
In Jun/2003 I had to go to an emergency room, at the time I was in a PPO insurance plan, and I presented the hospital with all the insurance info. About 2 mo later I start receiving bills from the hospital (Labs, docs, etc), then I found out they had the wrong insurance address, I informed the address again and thought everything was ok.
2004, I started receiving bills again about the same case, at this point the insurance won’t pay because the period to claim has expired, then I involved my husband’s employer in the case and let them handle the case.
End of 2005, I received a collection letter for the hospital. The Employer no longer exist. The insurance say they can’t locate my file because since the employer doesn’t have an account with them anymore they sent all the files back to the employer (?).
I’ve worked very hard to keep my credit in a good stand. The collector offered me a 35% discount on my “hospital bill”. Should I pay this and fight with the insurance later? If I pay the hospital wouldn’t that be an open door for all the others to come after me (docs,labs,etc) ?
What should I do?
Answer
Yes. Actually when there is a dispute with the insurer, it is always best to pay the bill yourself and try to recoup the $ from the insurer directly. Otherwise it is going to continue to affect your credit rating.
Answer
Yes. Actually when there is a dispute with the insurer, it is always best to pay the bill yourself and try to recoup the $ from the insurer directly. Otherwise it is going to continue to affect your credit rating.
That's bull!
You will never get anything from insurance yourself, unless you follow correct procedure.
1) Call insurance to find out what to do. Make sure you get someone who knows exactly your kind of situation. Follow their instructions.
2) Call collection agency to find out if they do submit to credit agency. Many don't. Regardless, notify them that you are disputing the claim through insurance. Ask them to put this matter on hold until resolved.
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That's bull!
Easy to say since it is not your credit at stake.
The advice given by purple2 was on target and should be heeded.
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I'd give it ~ 0% chance any of the paid sum would ever be recovered from insurance. Please do prove me wrong if ANYONE ever was able to recover what they paid to collector.
Granted, credit history is important, so working with collector is the way to go, but working and paying are two different things. Collectors do have clauses in their letters as to disputed claims. If you have a legitimate dispute, don't pay a cent, just tell collector to put this on hold until dispute is over.
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working with collector is the way to go, but working and paying are two different things. [quote]
Collection agencies have a way of getting your attention, regardless of your ability to pay.
Chances of collecting from the carrier . . . zero, but you can try.
Chances of getting the collector off your back if you don't/can't pay . . . zero, but you can try working with them.
Services were rendered and the provider is entitled to payment. Somewhere folks get the idea that docs & hospitals provide care just because they find it fun. They are a business and deserve to be paid.
When you go to a provider you (or your representative) signs financial responsibility forms. If an assigned third party does not pay, the provider comes looking for you to pony up. If you can't/won't they turn you over to a collector.
There is nothing in this thread that indicates the original party has absolutely NO liability for paying the debt. Where is the grounds for disputing the collectors claim? It isn't evident here.
Answer
Dispute is not with collector, it's with the hospital and insurance. OP is entitled to proper insurance claim submission by the hospital, and there are checks and balances in place to make sure the submission can be re-done after the deadline (hospital submits explanation like wrong address). Someone in the hospital billing office screwed up. There are plenty of incompetent people, and one incompetence is building on another in this case.
Again, the first thing to do is call insurance, and find out what their take on the situation is.
You should not have to get collectors off your back, and they know it. Ask collector what the proper procedure for putting the issue on hold (without reports to credit agency), until dispute is ower. Write a letter if needed, paper trail is always good.
I would also suggest writing a complaint to the hospital director/head/whatever, in case you get no cooperation from the billing office. This does not mean you are escaping your responsibility to pay. You fulfilled that responsibility when you presented proof of insurance, paid the co-pay, and maintained proper insurance throughout your hospital stay (by paying monthly premiums). No more responsibility is required, assuming the services you received were covered by your policy at the time of the treatment.
Answer
Easy to say since it is not your credit at stake.
The advice given by purple2 was on target and should be heeded.
I am glad someone agrees.
The problem here is that when you present to ANY office for medical care, the patient always signs this piece of paper guaranteeing payment be made.
The patient is always liable for any and all charges - that way if the insurance fails to pay the patient can and will be held responsible for the charges. The only time this is not the case is in the Medicaid program.
That paper is the key. And the hospital will have -at minimum -a copy of that paper with OP's signature on it.
So, since insurance didn't pay - for whatever reason, seems to be a problem with the billing address - the patient should pay, and file a claim with the carrier. They WILL consider the charge. A written letter of appeal probably will need to be done. I know for certain that the insurance carrier will reimburse the patient their allowed amount.
What the OP should do, negotiate a payment and pay it. With the written letter of appeal, she (or he) should attach the receipt they get from the collections office proving the amount was paid.
This way, the carrier knows it was paid, and also how much. They won't want to reimburse the member $100 if she only paid $85 - otherwise she'd be "profiting" off the visit. But they should reimburse minus whatever the ER copay is ($50?? usually)
If you (OP) need help with the written letter of appeal, send me a private message and I will be more than happy to help you. I've done so in the past with positive success.
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I maintain that the first thing is to call insurance. They may very well suggest the same thing, paying collector/hospital and submitting yourself (bearing any differences in charges on your own).
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I'd give it ~ 0% chance any of the paid sum would ever be recovered from insurance. Please do prove me wrong if ANYONE ever was able to recover what they paid to collector.
I have recouped $ I paid to healthcare providers after the insurer corrected their erroneous denial of payment.
Are you in the medical, insurance, or legal industry yourself?
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I have recouped $ I paid to healthcare providers after the insurer corrected their erroneous denial of payment.
Are you in the medical, insurance, or legal industry yourself?
As I said, do prove me wrong, it's good to know someone was successful with that approach
I am in the industry of using insurance correctly, and not get into situations when I have to pay directly. That's because one time I did (a while ago), I never saw my money again. No self-submitted forms or complaints helped (and I was supposedly fully covered).
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I have self submitted for myself and received reimbursement.
I have also assisted patients in our practice appeal with a great deal of success.
If you're not getting reimbursed, perhaps it was excluded from coverage in the first place