Health Insurance/Collections

[Whiskee]

What is the name of your state?

What is the name of your state?

California

This post was also posted in Health Insurance Forum, but thought it may belong here. I'm so lost I don't know what to do?

I was treated by an in network chiropractor from Oct-Dec 2001 (12x). In error I paid $15 co-pay each visit ($195 total). Insurance processed 3 claims correctly as in network; 9x processed incorrectly as out network resulting in a $300 out of network deductible. Insurance requested biller to resubmit claims as in network. Biller’s verbal proposal to me: Rather than resubmit as in network, he would accept $195 as paid in full. Biller refused to place proposal in writing. Biller claims provider is not in network. Biller did not honor his word and sent me a $300 bill threatening to send me to collections in 30 days, then 2 days later threatening to send me to collections in 10 day. Later, biller offered another proposal as a compromise: Biller would accept $155 ($150 in network deductible which they claim I haven’t met, but insurance confirms it is met) otherwise collections for $300 will be pursued. Due to biller’s incompliance to resubmit, insurance recalculated 9x claims as in network. Biller has sent my bill for $450 + $36.37 interest (for what I don’t know. Original bill was for $300) to collections. On 4/3/03 or 4/4/03 I expect a letter from the insurance verifying the provider is in network and all EOB’s.

I fear that even with Unicare’s letter of in network verification, the biller will not remove my account from collections as he is determined to make things as difficult as possible for me by ruining my credit report.

This battle has been going on since Dec 2001. Biller has not refunded insurance overpay and has $195 from me. Insurance states my responsibility $114.94. Thusly, provider owes me a refund of $80. How can I make biller remove the increasing collections account and refund my payment? I no longer have the returned checks but do have my checking register. Do I need to get copies of the checks and statements from my bank? Or one or the other suffice? My payment $195 even though bill is unjust aren't reflected in the bill. How do I prevent this from escalating and prevent from being sent to further collections? If biller removes account from collections, is it also removed from credit reports?

Any advise is appreciated.

Thanks,
Whiskee

 

[kevinss]

This is such a mess, you'll need to sort it out with a lawyer. These idiots are obviously messing with you and throwing your funds around like Monopoly money.
If you can get the original creditor to pull the bill back in, it's still VERY unlikely that the collection account will come off your credit report. You'll need to have a lawyer handle the entire case. He will then give you advice (or help you) to get your credit report cleaned up after the fact.
If you still have trouble after all of that, this forum can help you with credit-related items.

Good luck! It's unfortunate that this happened to you

 

[Whiskee]

Thanks Kevin

Hi Kevin,

Thanks for affirming what a mess it is. lol I've checked out the state bar of California to find an attorney. It's escalating beyond my comprehension and ability to defend it. I'll let you know how it goes.

Thanks for the advice,
Whiskee

 

[Whiskee]

I have phoned collections which will place a 30 day hold on the account. Once I receive the verification from insurance that doctor is in network at time of service or IF I don't receive the letter, what do I say in the letter to hold them off other than I am disputing the bill. Do I say I'm seeking legal representation? Or just not send a letter and find a lawyer (which I'm trying to do but not successfully). I'm currently waiting for a call from one from a law company through EAP at my work. I don't know if they will be able to assist me as though it appears they just offer counsel. But I need someone to make a phone call and send a letter. Time's ticking and I still don't have a lawyer!!

Please advise,
Whiskee

 

[Whiskee]

I have received counseling through an attorney through my work EAP. What he would do in this situation would be to pay collections and name doctor, collections and insurance company in small claims court. Hiring an attorney would be more costly than paying $486.37.

Another attorney suggested contacting a lawyer where I can pay a flat fee to make a call to the doctor and write a letter indicating I'm not responsible for the debt with insurance verification. How do I find???

Anyone else agree or have other suggestions?

How does my credit report get cleared after I pay?

I'm so unhappy!!!
Please advise,

Thanks,
Whiskee

 

[kevinss]

You're still dealing with an original biller and not a collection agency, so there's really nothing you can do shy of not answering your phone when they call. If you are being contacted by a collection agency, please correct me. If you do get a lawyer, you can refer them to him/her, and have him/her contact them to demand they stop contacting you. Confusing, huh?
When you work out the details with the biller and insurance company, make sure you get something in WRITING from the biller that states the account is paid in full, then you can dispute with the credit reporting agencies to get your actual credit cleared up.
Like I said before, this screams litigation, and I'm not sure how you're going to get the biller to place the information you want on your credit report. Since they think they're right, they probably will not change your credit report to reflect the truth of the matter - they will leave it as "he didn't pay, he didn't pay, he didn't pay, he finally paid."
If the biller does atmit fault, demand IN WRITING that they provide you, IN WRITING, with proof. Once you have that, you can dispute with the credit reporting agencies, sending them a copy of the letter as proof. If they STILL don't clear it up, you may need to threaten them with a lawsuit for knowingly reporting false information, but that's a while off still.
Work on getting the biller to report positive information to the bureaus or remove the account entirely, since the account should never have been created if what you say is correct.

 

[Whiskee]

Hi Kevin,

Thanks for the continued interest in my problem. I am dealing with collections. I do not wish to speak to doctor's office vis a vis the ugly biller. Hiring a lawyer costs more than the $486.37 debt. The doctor has $195 from me which wasn't even calculated in the $300 now $486.37. I've requested copies of my checks and statements to show payment. Maybe at least I can get the amount reduced to $291.37. I don't think I've ever received a correct statement or bill from the doctor. At a standstill as I don't have insurance verification that doctor is in network a correct amount for which I am responsible.

If I hire an attorney for $250/hr., can his fees be calculated into the amount I'm sueing for? I'm not even sure how to calculate that amount. I think I would be owed a refund of $80.06, $50 for copies of statements and checks, days' wages and time, aggravation spent on phone, stress! Shouldn't there be more? Do I sue for the amount they're sending me to collections for? If I sue all doctor, collections and insurance, how do I arrive at an amount?

I feel nauseous!

Thanks,
Whiskee

 

[kevinss]

Don't get nauseous over it.. it's not that big of a deal Try to settle down.

Since it's a collection agency, they're bound by the FDCPA. Read up on it:
http://www.ftc.gov/os/statutes/fdcpa/fdcpact.htm

If you don't want to hear about it again until you've had time to deal with the problem, send them a cease and desist letter. A sample can be found here:
http://www.creditinfocenter.com/forms/sampleletter7.shtml

Send the letter certified, RRR. Once they receive, they must stop contacting you immediately.

They may attempt to sue you (that's always a risk they take) but it's unlikely that they will move anytime soon on such a small debt.

Be diligent and keep after all parties involved.

 

[Whiskee]

Hi Kevin,

I'm hoping I'll know more tomorrow. No collections is not hounding me, in fact, they may be able to help.

But do you know if attorney's fees can be calculated in the judgement I seek as the plaintiff? Anyone?

Thanks,
Whiskee

 

[kevinss]

Yes, if they were negligent and caused you damages. I'd say this whole mess would be considered damaging. You will definitely need to talk to your attorney about that, though. This forum provides general info... can't say for sure what your circumstances warrant.

 

[Whiskee]

I spoke with an attorney, but he says I cannot recover the costs of attorney fees as I did not sign an attorney fee provider contract. I'm having a copy of my medical file sent to me. I think I only signed an agreement to bill insurance and informed consent. Looks like I'll have to go the small claims route even though I don't want to. He suggests I name everyone which makes me nervous, but I guess they can battle it out. Guess I'll have to make a trip to the court house and file.

Will update next week.

Thanks,
Whiskee

 

[Whiskee]

I spoke with insurance company and they're going to send me all my corrected EOB's. With this calculation, my responsibility is $114.94. I have already paid the provider $195. I am owed a refund $80.06. Once I send via certified mail the EOB's and copies of checks and statements along with a letter of dispute, does collections remove the account or does the original creditor? And does collections notify original creditor to refund my overpayment?

But there is yet another delay. I discovered that one of the dates of service is wrong. Insurance has it as 11/12/01 as it was received by the provider. It should be 11/21/01. This shouldn't affect the amount, but I fear this will cause another delay. Anyone's thoughts. I just want my information to be correct. Should I have let this one go or did I create more problems and delays???????

When will this end?!!!!



Thanks,
Whiskee

 

[kevinss]

You can get this fixed with the bureaus, but it will be a headache. Having warned you, here's what you should do:
First, send a letter to the collection agency letting them know what happened. Provide copies of all of your paperwork. Let them know that they must remove the incorrect collection listing from your credit report and that failure to do so will result in legal action. Remind them towards the end of the letter that you've provided them with records to indicate clearly to them that the listing is incorrect.
If that fails, send copies of all of your "evidence" to the credit bureaus. Dispute the collection as incorrect. They'll probably send you back something stating that it is correct, blah blah blah. Then, send them a letter informing them that it is illegal for them to report information that is not correct on your credit report, and that you have provided them with all of the information they need to prove that the listing IS incorrect. Let them know that you will be filing a complaint with the FTC if this matter is not resolved in a timely fashion.
That should give them enough motivation to clear it up for you.
If that fails, file a complaint with the FTC and get legal counsel - you should be able to recover all fees and costs associated with a lawsuit against the collection agency and/or the credit bureaus, as they're clearly in the wrong. It shouldn't get to that point, though.

 

[kevinss]

I almost forgot your second question.
Don't be too concerned with the dates unless matters escalate or are impeded as a result. This is too close to "over" for you to perpetuate it on a technicality. Let THEM draw it out if they feel it's important.

 

[Whiskee]

Thanks Kevin,

Yes, I'm hoping I didn't cause another delay by advising the provider of the incorrect date. I was just afraid that the incorrect it would cause further problems. The date shouldn't affect the calculations but wanted everything correct. The insurance has so mishandled my claims and the provider not being compliant has made me so paranoid that the dates would mess things up further. How dare the insurance infer that I'm being a pest with my numerous calls. I certainly agree it should have only taken one instead of 25! This has been a tremendous waste of time and both insurance and provider blame me.

Thanks so much for the information as to how remove the account from the credit reports if collections does not.

I'll keep you posted.

Thanks!!!
Whiskee