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  1. #1
    Stiffed? Guest
    Lived in Missouri and received ER care. Provided health insurance info to hospital, ambulance - whoever asked. Claims were processed and I paid co-pays ($50)and thought everything was square. A year later, received collection letter (never received a bill) which was from ER doctor. Provided insurance info to collection agency and was told not to worry about it, they would file claim.

    Moved 3 times in 3 years and now live in North Carolina. Mail catching up with me and alleged debt has apparently transferred between several collection agencies in Florida.
    They claim I need to pay full debt plus interest and threaten to ruin credit rating.

    Health insurance company maintains contract with physician stipulates physician is not to contact patient to recover debt if they fail to file a claim on a timely basis (1 year). Collection agency says it doesn't matter. They have only partially responded to 3 letters requesting proof of debt, filing of claim and reason insurance did not pay.
    I paid for health insurance, provided insurance info on request and am willing to cover any co-pay. I do not believe I am responsible for full debt because physician did not file claim in time. That is the purpose of paying for health care coverage right?

    I'm working 2 temp jobs, studying, etc. to stay afloat but have always had excellent credit and never missed a bill payment. Time to make calls and write letters to collection agency is a premium right now but will do what it takes to get on with my life (except pay for what I do not feel I owe).

    Please advise what my rights are, whether I am liable for the debt plus interest and how I can efficiently resolve the matter.

    Many thanks
  2. #2
    bigun is offline Senior Member
    Join Date
    May 2001
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    7,146
    Even though time is tight, I think you need to make some time. I'd contact the insurance company and tell them the problem and ask them to contact the doctor and the collection agency. I'd also contact the doctors business office and recite the clause in the contract you are referring to. I'd then tell the collection agency that it is a legal matter between the doctor and insurance company and send them a copy of that section of the contract. Tell them to cease and desist contact except by mail. Finally, I'd write my state attroney general and tell them that the collection agency is illegally attempting to collect a debt after they have been informed of the contract between the insurance co. and the doctor. As the AG for help. Finally, take the contract to a lawyer. You may have the basis for a law suit against the doctor and the collection agency.

    P.S.

    Be sure the CA gets a copy of the complaint you file with the AG.
  3. #3
    Stiffed? Guest

    One more question

    Many thanks for your guidance!

    One more question - please clarify exactly what is contained in a cease and desist letter. I did a search and found examples related to intellectual property and one sample to a collection agency that was a bit threatening in and of itself (at [url]http://www.bendover.com/ceaseletter.asp)-[/url] more than I want to project - especially if I can't afford to carry out what it suggests.

    I think I know what you mean but want to be sure.

    Again, thanks for the good advice.
  4. #4
    bigun is offline Senior Member
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    May 2001
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    7,146
    Nothing elaborate. Just send a letter saying you are instructing them to make no more contact with you by phone. The only acceptable contact is by mail. Send it registered with a return receipt.
    Also, kep a notepad by the phone and if they continue to call, write down names and times. If it happens more than a couple of times, see a lawyer. Many states have harrassing communications legislation that may be pertinent to your situation. Good luck!
  5. #5
    tater_tot is offline Member
    Join Date
    Jul 2000
    Location
    Tazewell, Virginia USA
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    193
    I have a similar situation except in my case my husbands ex-wife turned in medicaid as the primary insurance and then when the children were dropped from medicaid she didn't turn in the insurance and some of it we haven't found out until years later when some doctors are starting to come after us, but we have contacted the insurance company and they said their allowable time was 15 months, but if we sent proof of the debt, and that the children were covered at the time of the medical situation that they would pay it. They wanted like a copy of the papers that you sign when you are admitted to the hospital or the papers you sign to go into the ER (which has dates and signatures). I hope this helps. I live in VA, but I think in this case an insurance would have to cover the medical expenses as long as they were incurred while you were covered on the insurance and you can prove the debt. Good Luck!!!!
  6. #6
    jdc/dallas Guest
    I have billed and collected insurance claims for over 20 years. You need, if possible, to get your EOB (explanation of benefits) from the insurance company stating claim was denied for timely filing. It will also say this claim can not be billed to the patient.

    Once you have obtained that you need to get in touch with the hospital business office and advised them if them do not correct this with their collection agency, you will file a complaint with your state insurance commission. Always speak to someone in management.

    Anyone that works in medical insurance knows that when a claim has been denied for timely filing, that bill can not be passed on to the patient or guarantor. The debt has to be written off. Your action should be to contact the insurance company you had at the time of service and from there the hospital as they are the one that sent the collection agency after you.
  7. #7
    Stiffed? Guest

    Status Update

    It is 2 years later and this issue is still only partially resolved.

    To summarize, I never heard anything more once I sent the last collection agency a letter disputing the claim (it's the 4th or 5th agency I've done this with). I again explained that I was insured at the time, the physician had not filed on a timely basis, etc. I also requested proof of the debt so I could obtain information about the ER physician and his company. I didn't hear anything more so figured the collection agency researched the issue and decided the claim had no merit.

    About 6 months ago, I try to buy a modest little condo and find that 2 of the collection agencies have made reports to credit agencies and my loan won't go through until it is resolved.

    I start another campaign with the insurance company to get proof of their rejection of the claim. I blitz the company with daily letters faxed to a number I'm able to obtain in addition to calls to the home office, the regional office and the attorney general's office of the insurance company's home state.

    Each person who responds to me, tells me after researching the matter, they can no longer find the record, their notes of my interactions with them and cannot help me. I call the collection agencies on the credit report and ask how they can mar my credit when a cease and desist letter disputing the claim should have prevented this. Since neither company owns the debt any longer, they remove their claim.

    I no longer know who has the collection. I did receive a collection letter 2 months ago but my name was not on the letter, the debt was not an amount I'm familiar with and the debt was with a bank I've never banked with. I sent the first cease and desist letter detailing the type of proof I needed and setting a 30 day time line for response and heard nothing. I sent a second letter requesting the information again, establishing that I've never received a response to my first letter and stating I will lodge complaints with the attorney general's office, the local and national BBB, etc. unless I get a response in 3 weeks. That timeline has come and gone. I plan to follow through with my complaints.

    BUT -- out of the blue, I receive a check from the insurance company for the full amount of the claim!

    I want to turn this money over to the original physician's company but since it was an ER doc with his own company in the hospital (and the hospital was paid for emergency services - his company is the one that claims the were not paid.) - I never really knew his name. The hospital won't provide any information - they were paid, that's all that matters to them.

    I have not been able to track down the doctor or the company (and neither has the investigator for my insurance company). The collection agencies have never provided this information. I no longer know which collection agency has my alleged "debt". I don't know if the recent collection letter is mine since all the information is wrong.

    Any advice? I want to pass the insurance check to the physician's company and want all the various collection agencies to close out my file.
  8. #8
    bigun is offline Senior Member
    Join Date
    May 2001
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    7,146
    Wow, what a saga.
    Got no idea how to find the doctor but, I'd suggest you dispute the listing with the CRA's as not mine and see if it falls off.

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