Account in Collections - How to dispute
June 14, 2011 7:14 PM Subscribe
Need with help on what to do with medical account in collections that Insurance has already paid for.
This is an extremely long story that has had many mishandled billing and account practices from both the physician’s office and my insurance company. I am trying to limit the amount of information to be concise but to provide enough information so hopefully this community can help me make some important next steps on this issue.
In Feb. 2010 I went in for a hospital emergency visit twice in the same day for the same complaint. I live in Iowa and the hospital I was admitted to is in Iowa.
In Jan. 2011 I received a “physician bill” for the physician portion of my emergency portion of my visit. This was a bill for the second visit I made to the hospital in Feb. 2010. This bill had long since been paid and the amount I was asked to pay, roughly $250, was considerably more than my last payment, roughly $80.00.
I then called the billing office (third party billing office) and the explained that in Aug. of 2010 my insurance company requested a “refund” that they overpaid for this visit and that refunded portion amount was now patient responsibility. I then called the insurance company and they confirmed that the account was mishandled and the billing department was asked to refund money to the insurance company that was credited by to my HRA (health reimbursement account). However, the remaining balance after the refund was then picked up by the insurance company as part of the policy benefits. (I am actually OWED $40 for over paying the physician’s office) For 4 months (over 33 hours voice time on the phone) I acted as the “mediator” between the insurance company and the billing department, several three-way calls all of which I was promised that the issue would be investigated by the physician billing department and insurance company yet I continued to get bills in the mail.
Today I received a collection letter that the account is now in collections. Again I called the billing department (had to leave a message with a supervisor – doubt I will get a call back). Called the insurance company and again they will call the billing department and contact them to “clear it up.”
I have copies of all explanation of benefits showing how payment was dispersed and the correction made when it was mishandled by the insurance company. I have copies of all times and amount of time spent on the phone working with both sides.
Statement:
I will NOT pay the amount requested, even if it is cheaper than going the legal amount.
Here are a couple of my questions:
• How long do I continue to play mediator here before I take the next step of legal action?
• Now that the account is in collection – do I even bother working with the physician billing office?
• I looked up sample letters to respond to the collection agency within the 30 day time span for disputing the debt but questions on that – since I am already aware of this “dispute” I am I disputing the debt? Or am I disputing that the debt has already since been paid? (Any one have a suggestion of verbiage or sample letter to use?)
• Any other suggestions?
This is an extremely long story that has had many mishandled billing and account practices from both the physician’s office and my insurance company. I am trying to limit the amount of information to be concise but to provide enough information so hopefully this community can help me make some important next steps on this issue.
In Feb. 2010 I went in for a hospital emergency visit twice in the same day for the same complaint. I live in Iowa and the hospital I was admitted to is in Iowa.
In Jan. 2011 I received a “physician bill” for the physician portion of my emergency portion of my visit. This was a bill for the second visit I made to the hospital in Feb. 2010. This bill had long since been paid and the amount I was asked to pay, roughly $250, was considerably more than my last payment, roughly $80.00.
I then called the billing office (third party billing office) and the explained that in Aug. of 2010 my insurance company requested a “refund” that they overpaid for this visit and that refunded portion amount was now patient responsibility. I then called the insurance company and they confirmed that the account was mishandled and the billing department was asked to refund money to the insurance company that was credited by to my HRA (health reimbursement account). However, the remaining balance after the refund was then picked up by the insurance company as part of the policy benefits. (I am actually OWED $40 for over paying the physician’s office) For 4 months (over 33 hours voice time on the phone) I acted as the “mediator” between the insurance company and the billing department, several three-way calls all of which I was promised that the issue would be investigated by the physician billing department and insurance company yet I continued to get bills in the mail.
Today I received a collection letter that the account is now in collections. Again I called the billing department (had to leave a message with a supervisor – doubt I will get a call back). Called the insurance company and again they will call the billing department and contact them to “clear it up.”
I have copies of all explanation of benefits showing how payment was dispersed and the correction made when it was mishandled by the insurance company. I have copies of all times and amount of time spent on the phone working with both sides.
Statement:
I will NOT pay the amount requested, even if it is cheaper than going the legal amount.
Here are a couple of my questions:
• How long do I continue to play mediator here before I take the next step of legal action?
• Now that the account is in collection – do I even bother working with the physician billing office?
• I looked up sample letters to respond to the collection agency within the 30 day time span for disputing the debt but questions on that – since I am already aware of this “dispute” I am I disputing the debt? Or am I disputing that the debt has already since been paid? (Any one have a suggestion of verbiage or sample letter to use?)
• Any other suggestions?
If you can afford to lose the $250, go ahead and pay it just to get some closure. In a perfect world you would be able to get this all cleared up, but in reality convoluted mistakes of this nature can drag on for a long time and you probably don't need the constant stress and hassle.
But, if you can't afford to lose the $250, write a short note to the collections agency (a note by snail mail, don't ever communicate with a collections agency by email or phone) and say "There is no bill to "dispute" as this debt has already been paid by my insurance company. Your information is in error. Please do not contact me any further regarding this matter."
If they escalate, you can direct them to call your insurance company or you can forward your proof to them. Once you've forwarded your proof, along with your repeated request that you not be contacted any further, you can threaten them with your state attorney general's office.
posted by amyms at 10:41 PM on June 14, 2011
But, if you can't afford to lose the $250, write a short note to the collections agency (a note by snail mail, don't ever communicate with a collections agency by email or phone) and say "There is no bill to "dispute" as this debt has already been paid by my insurance company. Your information is in error. Please do not contact me any further regarding this matter."
If they escalate, you can direct them to call your insurance company or you can forward your proof to them. Once you've forwarded your proof, along with your repeated request that you not be contacted any further, you can threaten them with your state attorney general's office.
posted by amyms at 10:41 PM on June 14, 2011
Response by poster: Hi All - Thanks for the suggestions here but not sure if you saw my notes below and specific questions. At this time, I am not ready to pay the amount, not to say that may change, but I am almost 6 months into this and right now I am not interested in paying to make it go away.
Please see my specific questions on the type of letter to send. I am familiar with my options via the FDCPA, but have questions on the actual request I am making.
Questions I have:
How long do I continue to play mediator here before I take the next step of legal action?
• Now that the account is in collection – do I even bother working with the physician billing office?
• I looked up sample letters to respond to the collection agency within the 30 day time span for disputing the debt but questions on that – since I am already aware of this “dispute” I am I disputing the debt? Or am I disputing that the debt has already since been paid? (Any one have a suggestion of verbiage or sample letter to use?)
posted by lutzla23 at 10:58 PM on June 14, 2011
Please see my specific questions on the type of letter to send. I am familiar with my options via the FDCPA, but have questions on the actual request I am making.
Questions I have:
How long do I continue to play mediator here before I take the next step of legal action?
• Now that the account is in collection – do I even bother working with the physician billing office?
• I looked up sample letters to respond to the collection agency within the 30 day time span for disputing the debt but questions on that – since I am already aware of this “dispute” I am I disputing the debt? Or am I disputing that the debt has already since been paid? (Any one have a suggestion of verbiage or sample letter to use?)
posted by lutzla23 at 10:58 PM on June 14, 2011
How long do I continue to play mediator here before I take the next step of legal action?
After 33 hours of phone calls, what's left to say? Have you tried a 3-way call between yourself, the insurer and the billing office? If you have, did the insurer and billing office acknowledge the same version of events? Do they agree on the phone that you're right and then keep sending you a bill anyhow? There's no particular amount of time that you should spend on the phone here.
It sounds as if it might be time to handle things more aggressively and more forcefully. If you're certain that you're right and it's crystal clear where things went wrong (e.g. 'payment C on xx/ww/zzzz wasn't applied to my account number 1234567-a') then send clear documentation, with appropriate highlighting and notation, to the billing office, along with an explanatory letter. If you're doing everything by phone then you have no evidence of what's been said, you may be talking to different people each time and it's just messy. Also, never keep talking to someone who obviously can't help you. Escalate. Demand to talk to a manager. Tell them you've spent a ridiculous amount of time on this and it has to get ironed out now or you'll be calling the state AG. Don't get openly mad and fighty, but be extremely assertive and hold their feet to the fire.
posted by jon1270 at 3:23 AM on June 15, 2011
After 33 hours of phone calls, what's left to say? Have you tried a 3-way call between yourself, the insurer and the billing office? If you have, did the insurer and billing office acknowledge the same version of events? Do they agree on the phone that you're right and then keep sending you a bill anyhow? There's no particular amount of time that you should spend on the phone here.
It sounds as if it might be time to handle things more aggressively and more forcefully. If you're certain that you're right and it's crystal clear where things went wrong (e.g. 'payment C on xx/ww/zzzz wasn't applied to my account number 1234567-a') then send clear documentation, with appropriate highlighting and notation, to the billing office, along with an explanatory letter. If you're doing everything by phone then you have no evidence of what's been said, you may be talking to different people each time and it's just messy. Also, never keep talking to someone who obviously can't help you. Escalate. Demand to talk to a manager. Tell them you've spent a ridiculous amount of time on this and it has to get ironed out now or you'll be calling the state AG. Don't get openly mad and fighty, but be extremely assertive and hold their feet to the fire.
posted by jon1270 at 3:23 AM on June 15, 2011
Ooops.
it might be time to handle things more aggressively and moreforcefully formally.
posted by jon1270 at 4:23 AM on June 15, 2011
it might be time to handle things more aggressively and more
posted by jon1270 at 4:23 AM on June 15, 2011
I looked up sample letters to respond to the collection agency within the 30 day time span for disputing the debt but questions on that – since I am already aware of this “dispute” I am I disputing the debt? Or am I disputing that the debt has already since been paid? (Any one have a suggestion of verbiage or sample letter to use?)
If you're absolutely sure that your version of events is correct, then a short note like I mentioned above is a good first step:
"I am writing to inform you that your information is in error. There is no debt to 'dispute' as the original bill has been paid by my insurance company. Please do not contact me any further regarding this matter."
posted by amyms at 4:37 AM on June 15, 2011
If you're absolutely sure that your version of events is correct, then a short note like I mentioned above is a good first step:
"I am writing to inform you that your information is in error. There is no debt to 'dispute' as the original bill has been paid by my insurance company. Please do not contact me any further regarding this matter."
posted by amyms at 4:37 AM on June 15, 2011
I have once in the past had success getting collections off my back when I told them (truthfully) that there had been an error and the debt wasn't actually mine. So you might try amyms's idea. Apparently, though (again, per what the person told me in my own AskMe), medical collections are less flexible--not able to make deals for lesser amounts, for instance. I assumed that they were less shady than other collections, but I still followed advice I got like not giving them any new information about me. For instance, don't make payment with a check that has your account number on it; do it with a money order. And don't sign any letters you send, as you don't want a shady collections agency to have a copy of your signature.
If it helps, here is the letter I sent to the collection agency. I got the format mainly from a sample letter on a credit board. In my case, I offered to settle for a smaller amount and they rejected the offer. This was after I had requested, and been sent, their documentation on the debt ("proof of debt").
Re: Name of clinic
Account # 1015511046
Thank you for sending me a copy of the proof of debt after my initial phone call with your representative.
I do not concur that I am liable for this debt. Per information provided to me in a phone conversation with a representative of my insurance company (named Amy) on July 13, 2010, this bill would have been paid by my insurance company if it had been properly billed. On that date, Amy spoke directly with the billing office at Name of Clinic and was told they would re-submit the bill with the proper billing code. Apparently, this was not done and the bill was instead referred to collections.
Therefore, I continue to maintain that I am not liable for this debt as it would have been paid by my insurance company had Name of Clinic billed my insurance with the correct billing code.
However, since the debt has been sent to collections, I do not anticipate being able to get recourse from Name of Clinic. Therefore, I am willing to settle this debt with you.
I propse to pay $50 to settle this debt in full. In addition, any reference to the debt will be removed from my credit reports.
You may consent to this by signing and returning this letter. I will send a money order in the amount of $50 within 15 days of receiving your consent.
My name
Signature of CBCS representative agreeing to above terms: _________________
Printed name of CBCS representative: __________________________
I tell you, though, that as much as it stung at the time, paying the $150 and getting this stressful issue off my plate was a good choice. You're invested the equivalent of four working days into trying to recover $250. I wish I could get someone to give me four days of work at that price!
posted by not that girl at 6:17 AM on June 15, 2011
If it helps, here is the letter I sent to the collection agency. I got the format mainly from a sample letter on a credit board. In my case, I offered to settle for a smaller amount and they rejected the offer. This was after I had requested, and been sent, their documentation on the debt ("proof of debt").
Re: Name of clinic
Account # 1015511046
Thank you for sending me a copy of the proof of debt after my initial phone call with your representative.
I do not concur that I am liable for this debt. Per information provided to me in a phone conversation with a representative of my insurance company (named Amy) on July 13, 2010, this bill would have been paid by my insurance company if it had been properly billed. On that date, Amy spoke directly with the billing office at Name of Clinic and was told they would re-submit the bill with the proper billing code. Apparently, this was not done and the bill was instead referred to collections.
Therefore, I continue to maintain that I am not liable for this debt as it would have been paid by my insurance company had Name of Clinic billed my insurance with the correct billing code.
However, since the debt has been sent to collections, I do not anticipate being able to get recourse from Name of Clinic. Therefore, I am willing to settle this debt with you.
I propse to pay $50 to settle this debt in full. In addition, any reference to the debt will be removed from my credit reports.
You may consent to this by signing and returning this letter. I will send a money order in the amount of $50 within 15 days of receiving your consent.
My name
Signature of CBCS representative agreeing to above terms: _________________
Printed name of CBCS representative: __________________________
I tell you, though, that as much as it stung at the time, paying the $150 and getting this stressful issue off my plate was a good choice. You're invested the equivalent of four working days into trying to recover $250. I wish I could get someone to give me four days of work at that price!
posted by not that girl at 6:17 AM on June 15, 2011
Presumably you've documented all of your interactions with the hospital's billing department and insurance company. If you're sure you're willing to let this drag out, I'd mail a dispute to the collection agency stating on what date you paid, on what date(s) you had phone calls, what the resolution reached in those calls was, and if possible who you spoke to at each organization.
The main risk by letting it stick with the collections agency is that they might be able to affect your credit history, although other posters can speak to that possibility better than I can. Really, if it was me, I would pay the (incorrect) bill and immediately start working on getting a refund. Once you're on the path of being a customer they deem a non-payer, even if incorrect, you're going to get stuck on that route.
posted by mikeh at 12:07 PM on June 15, 2011
The main risk by letting it stick with the collections agency is that they might be able to affect your credit history, although other posters can speak to that possibility better than I can. Really, if it was me, I would pay the (incorrect) bill and immediately start working on getting a refund. Once you're on the path of being a customer they deem a non-payer, even if incorrect, you're going to get stuck on that route.
posted by mikeh at 12:07 PM on June 15, 2011
Response by poster: Hi All – just some updates.
I sent a letter to the collection agency and exercised my right under the Fair Debt Collection Practices Act in accordance with the dispute, but still haven’t heard anything. Tried contacting the Hospital directly which wasn’t very helpful since they directed me to the billing department again (which by the way is outsourced, not unusual but interesting as maybe I can find a governing body/board that oversees this contact maybe).
At this point, I still pretty against paying – and actually surprised at how many people have suggested this. Maybe I will hate myself later for doing it, but it just feels incredibly inappropriate to give in at this point. I was hoping there may be someone out there who would suggest “talk to this agency” or “write a letter here to this group” or “report the issue here” but I assume that is me being naïve that that there is always a solution to “injustice” . Has anyone ever reported a hospital to the BBB? I think each state has an insurance advocacy group but I really don’t think this is an insurance issue, I think the issue is with the business office. Has anyone tried to fit this under Patient Advocacy issues (even though billing/financial really isn’t listed)? Or even the Joint Commission? In my opinion some of the practices appear to be unethical (unethical NOT illegal) (Example, billing office tried to file this “left over amount” with my insurance company; they denied it with the remark of “amount already paid”. Instead of following up with the insurance company to investigate this already paid amount or to dispute it, they automatically mark it as patient responsible, which again in MY opinion is unethical as I am sure majority or at least some patients would be pay this amount.) would there be any Auditing reporting groups I could submit to?
To answer some questions from everyone, Jon1270 and amyams. Am I sure that I do not owe this money? Well no, I’m not. I have two different parties saying two different things. I have the insurance company saying I don’t owe a dime, and the billing department at the physician’s office saying I do. Now what I DO have is my EOB (explanation of benefits) saying that the insurance company paid the amount in full and that the patient responsibility is $0. I have nothing of “proof” saying I owe the money from the billing department other than a statement I continue to receive each month. Have I tried a 3-way calling with insurance company and billing department? Yes I have, several times actually, about 5. Each time insurance company says “okay you were paid” here is XYZ proof. Billing department says, “OK we will research that and get back to the patient.” I never receive a response. Then, I get another bill I call and have to re-invent the wheel each time. I’ve left messages for supervisors (billing department) who have never called back. I’ve got three direct numbers for analysts and supervisors that don’t work. Do I have it the information documented? Yes, each call, each person I spoke with, each person I left voicemails with, each person who gave me a number that didn’t work, case numbers, all letters sent to me, all letters I’ve sent, etc.
posted by lutzla23 at 10:11 PM on July 5, 2011
I sent a letter to the collection agency and exercised my right under the Fair Debt Collection Practices Act in accordance with the dispute, but still haven’t heard anything. Tried contacting the Hospital directly which wasn’t very helpful since they directed me to the billing department again (which by the way is outsourced, not unusual but interesting as maybe I can find a governing body/board that oversees this contact maybe).
At this point, I still pretty against paying – and actually surprised at how many people have suggested this. Maybe I will hate myself later for doing it, but it just feels incredibly inappropriate to give in at this point. I was hoping there may be someone out there who would suggest “talk to this agency” or “write a letter here to this group” or “report the issue here” but I assume that is me being naïve that that there is always a solution to “injustice” . Has anyone ever reported a hospital to the BBB? I think each state has an insurance advocacy group but I really don’t think this is an insurance issue, I think the issue is with the business office. Has anyone tried to fit this under Patient Advocacy issues (even though billing/financial really isn’t listed)? Or even the Joint Commission? In my opinion some of the practices appear to be unethical (unethical NOT illegal) (Example, billing office tried to file this “left over amount” with my insurance company; they denied it with the remark of “amount already paid”. Instead of following up with the insurance company to investigate this already paid amount or to dispute it, they automatically mark it as patient responsible, which again in MY opinion is unethical as I am sure majority or at least some patients would be pay this amount.) would there be any Auditing reporting groups I could submit to?
To answer some questions from everyone, Jon1270 and amyams. Am I sure that I do not owe this money? Well no, I’m not. I have two different parties saying two different things. I have the insurance company saying I don’t owe a dime, and the billing department at the physician’s office saying I do. Now what I DO have is my EOB (explanation of benefits) saying that the insurance company paid the amount in full and that the patient responsibility is $0. I have nothing of “proof” saying I owe the money from the billing department other than a statement I continue to receive each month. Have I tried a 3-way calling with insurance company and billing department? Yes I have, several times actually, about 5. Each time insurance company says “okay you were paid” here is XYZ proof. Billing department says, “OK we will research that and get back to the patient.” I never receive a response. Then, I get another bill I call and have to re-invent the wheel each time. I’ve left messages for supervisors (billing department) who have never called back. I’ve got three direct numbers for analysts and supervisors that don’t work. Do I have it the information documented? Yes, each call, each person I spoke with, each person I left voicemails with, each person who gave me a number that didn’t work, case numbers, all letters sent to me, all letters I’ve sent, etc.
posted by lutzla23 at 10:11 PM on July 5, 2011
This thread is closed to new comments.
I did go so far as to write the collections agency and tell them I disputed the bill. They replied that they were assured by the clinic that the debt was real, and that they had no discretion to lower the amount I paid (I actually had written an AskMe about my situation, and this is exactly what someone with experience in medical collections had told me would happen).
If you call the hosptial, they will likely tell you that they can no longer do anything for you now that the bill has gone to collections. In my experience, this is not always true--I have gotten a hosptial to get a bill back from collections when it was sent there mistakenly. But they have to be willing to recognize that they made a mistake, and if you've already spent 33 hours on the phone trying to get someone to fix this, that seems unlikely. Also, the time I was able to get them to do this, I called within a matter of days, and I think the timeliness made a difference, too.
posted by not that girl at 7:51 PM on June 14, 2011