Healthcare Scam?

June 25, 2024 7:49 AM

A strange company keeps calling about my health care bills

I’ve been getting calls from a company that says "We are not a bill collector" but wanted to resolve issues with my health care bills and to call them back at a particular number.

After a few calls back and forth, I spoke to someone the other day. She had records of three medical visits of mine in the last six months for tests at a hospital. We went through them. They had some of the info correct, but some was wrong, like they had dates suggesting a continuous stay at a hospital instead of two separate tests on the beginning and ending of that time range. They only had a claim number for one of the visits.

She asked that I call the insurance company to get it sorted out. I have two insurances, an employer-based one (Blue Cross) and Medicare as my secondary. Sometimes, medical facilities mix them up, and they do need clarification. So, I got on the phone with Blue Cross and asked their rep about these visits and their payment.

The one with the claim number was denied because the hospital failed to get a pre-authorization. The rep said the hospital can open a dispute.

As for the other visits, Blue Cross had no record of them.

I tried to call back the other company to report back what I learned, but I only got a voice mail, and I left a message to call me back.

I then got another recorded call for this company about a medical bill from a different healthcare facility. (It’s owned by the same parent group as the other.) Yesterday, I got two letters in the US mail from this company about these issues, one for each facility.

But now I’m wondering why I’m doing this. What is this company? It’s called Knowtion Health, formerly Rsource. The website looks professional. It says they’re based in Florida, but I don’t live in Florida. Are they a scam? How much should I trust them with my info? Why are they spoofing a number in my area code when they call? (The number to call on the letters are Florida numbers, for what it's worth.)

Even if they’re not scams, why is it my job to sort out these healthcare bills and spend time on hold and trying to reach reps? I’ve got other things to do. If the hospital group has an incompetent billing department, it’s not my fault. Can I just ignore these calls and letters and block this company’s number without compromising my finances or having other adverse effects?

posted by Leontine to Work & Money (10 answers total)

I would go back to your insurance company and lean on them to sort this out. Something got screwed up somewhere even if this company doesn't read as scammy (to me).
posted by Alensin at 8:10 AM on June 25, 2024

I would ignore the calls, they can send a damn certified letter if they have legitimate business with me. Otherwise their issue with with the insurance companies and hospitals/providers.

I suspect they work in the manner of bill collectors, in that they buy batches of denied or screwed up claims and try to resolve them for a cut of the recovered payments.
posted by Lyn Never at 8:13 AM on June 25, 2024 [12 favorites]

I would ask the billing department of the hospital/clinic parent company if they know anything about this company. Knowtion says they help medical groups get paid for denied claims. They could have an office in your area code despite being headquartered in another state.
posted by soelo at 8:14 AM on June 25, 2024 [1 favorite]

Based on the paucity of web references to them other than their own website I would skip doing business with them. They might be legit, but even if they are they don't seem to have much of a reputation.
posted by Tell Me No Lies at 9:01 AM on June 25, 2024 [2 favorites]

Also note that the knowtionhealth.com domain was registered in Feb 2022., i.e. they haven't been around for that long.
posted by falsedmitri at 9:18 AM on June 25, 2024

Best answer: why is it my job to sort out these healthcare bills [...]

For me in the US state of NJ, whenever I receive health care from a new provider, one of the mountain of forms I sign is an agreement that I am responsible for any balances not covered by my insurance. Sadly, that makes it my job to make sure that my insurance pays them eventually. I won't receive health care without signing a form like this. Yes, this is unfair, inefficient, and symptomatic of a very broken system.

Seconding that you should contact the hospitals to try and sort out why you are hearing from Knowtion. The hospitals should have a better process for responding to initial insurance denials than immediately kicking it out to a 3rd-party collections-not-collections agency
posted by hovey at 9:31 AM on June 25, 2024

Your employer's HR determines your insurance providers and options. They should know who this company is and what role they play in your benefits.

I feel like third-party interferers are a growing trend in health care. Pharmacy benefit managers, separate prior auth companies. More middlemen to scrape off their share of the rent. Every time benefits selection time comes around in my experience there's a new option that sounds like a second-opinion manager? And I've also had an experience of during a time of heavy healthcare use, a nurse called to check on my overall picture, like there is another set of oversight from a company that BCBS uses to make sure we're not using healthcare willy-nilly.

Also, I don't see that you asked BCBS about this company?

As long as they're not asking for you to pay them (or another third party) directly, I don't smell scam ... yet.
posted by Dashy at 9:43 AM on June 25, 2024 [1 favorite]

The site says We help hospitals resolve denied and complex claims, recover low balance accounts and defend against payer audits... We help hospitals resolve denied and complex claims, recover low balance accounts and defend against payer audits. .. resolve claims faster and continuously optimize your A/R. So they sound like they may try to get claims paid before a bill goes to collection. Kind of a pre-collection agency. When a bill goes to collection, the hospital loses an even bigger percentage. I can't see why you'd be required to work with them if you choose not to. And I'd be unhappy about my medical records being shared.
posted by theora55 at 1:14 PM on June 25, 2024 [3 favorites]

Best answer: My employer calls this sort of thing "soft collections", as in "you haven't paid, would you like to so we stop calling you?" I think you can pay the hospital et al. normally... It's been a bit since I worked in that part of the biz.

hovey is right that receiving services makes it your job to get this shit done. Sucks, but true.
posted by fiercekitten at 8:01 PM on June 25, 2024

If two of those claims have not been presented to your insurer yet, that is step number one. Tell the hospital (not the third party) that they need to submit the bills to BCBS (or medicare, or both) and not bother you until that is done. Tell them about the pre-auth issue on the first one, too and suggest they file the dispute. If they have an email address instead, it might be more efficient for you to email them about all 3 of the visits.
posted by soelo at 8:11 AM on June 26, 2024