Disputed medical bill

[pigoi]

What is the name of your state? Illinois

The complicated events are:
2004: insured by HMO
2004, March: Child sick, goes to primary physician, who finds nothing
2004: two days later, child much worse, going to emergency room sent by primary physician. Thanks to hospital help, child recovers. This is ofcourse the most important.
2004, June: I am not longer using this HMO
2005, May: Collection agency asks $584, regular mail, for the hospital. Note: I have the same address even now.
2005, May: I answer with regular mail letter saying that I dispute the bill as HMO should cover the bills
2005, May: I call the primary physician whose office does not return calls
2006, April: Collection agency threatens judgement and credit report, regular mail. They say nothing about my previous letter
2006, April: I call the collection agency, who claims that hospital would not talk to me anymore. I asked for an explanation of the bill
2006, May: Collection agency sends a lists of medical procedures performed, total $584, regular mail
2007, January: Collection agency sends again medical procedures, threatening letter (judgement, credit report) - regular mail
2007, March: I send registered letter to hospital asking them to correct their mistake; among other I mention that their contract with the HMO prohibits them charging me (that worked with earlier bills sent to me directly by hospitals, who then stopped sending me bills)
2008, May: I checked my credit report, and the $584 appears, last updated Jan. 2007, supposed to dissapear in 2011. The charge was not there in March 2006

What are my options?
Am I legally in debt since I did not respond to the April 2006 letter,
and the May 2005 letter was sent by me using regular mail?

Who can sue me and when it is their last chance?
Can I force the primary physician to testify at the trial?
Can I force the hospital-HMO contract to appear the trial?
Can I get that contract from the hospital and the physicians' testimony without a trial,
if they don't answer my letters and calls?
I am worried that the physician will not admit sending me to the hospital;
after all he did it in a phone call. Phone records?

Does it make any sense for me to sue? Whom and by what deadline?
Wouldn't the lawyer charge me more than the debt?
Can the damage to credit be quantified and recovered? From whom?

Suppose no trial happens by 2011. Any way the debt is not removed from my credit reports?
Can the issue come back later?

I have the means to pay the bill but feel like that would be giving in to blackmail;
and now my credit is damaged anyway, right?

Thanks all for their opinion about what to do now.

[debtcollector`]

Originally Posted by pigoi

2005, May: I answer with regular mail letter saying that I dispute the bill as HMO should cover the bills

Not a valid dispute.

Originally Posted by pigoi

2006, April: Collection agency threatens judgement and credit report, regular mail. They say nothing about my previous letter
2006, April: I call the collection agency, who claims that hospital would not talk to me anymore. I asked for an explanation of the bill

And apparently you did nothing about this for 11 months prior to the CA calling.

Originally Posted by pigoi

2006, May: Collection agency sends a lists of medical procedures performed, total $584, regular mail

They responded to your validation request and gave you time to straighten it out.

Originally Posted by pigoi

2007, January: Collection agency sends again medical procedures, threatening letter (judgement, credit report) - regular mail

They aren't threatening. As soon as they determine that your file meet lawsuit criteria, you will be sued.

Originally Posted by pigoi

2007, March: I send registered letter to hospital asking them to correct their mistake; among other I mention that their contract with the HMO prohibits them charging me (that worked with earlier bills sent to me directly by hospitals, who then stopped sending me bills)

So, you tried to scam them.

Originally Posted by pigoi

2008, May: I checked my credit report, and the $584 appears, last updated Jan. 2007, supposed to dissapear in 2011. The charge was not there in March 2006

And after avoiding responsibility for more than two years and running the "contract" scam (yes, we have a name for it -- it is that common), you are surprised that good will has ended and they are beginning the process of getting their money. The are now researching your assets and employment to determine if you meet lawsuit criteria. If you do, you will get another chance to pay before being sued -- usually.

Originally Posted by pigoi

What are my options?
Am I legally in debt since I did not respond to the April 2006 letter,
and the May 2005 letter was sent by me using regular mail?

The question is just stupid. You are legally in debt because you used the services.

Originally Posted by pigoi

Who can sue me and when it is their last chance?

Anybody can sue you at anytime -- we have an open court system.

Originally Posted by pigoi

Can I force the primary physician to testify at the trial?

No YOU cannot.

Originally Posted by pigoi

Can I force the hospital-HMO contract to appear the trial?

If you have the contract in your possession, you could offer it into evidence; but their attorney will block that.

Originally Posted by pigoi

Can I get that contract from the hospital and the physicians' testimony without a trial,
if they don't answer my letters and calls?

You don't

Originally Posted by pigoi

I am worried that the physician will not admit sending me to the hospital;
after all he did it in a phone call. Phone records?

How about your medical record -- the referral should be in there.

Originally Posted by pigoi

Does it make any sense for me to sue? Whom and by what deadline?

Who the hell are you going to sue? You the one that doesn't pay her bills. The sheer audacity of debtors still amazes me.

Originally Posted by pigoi

Wouldn't the lawyer charge me more than the debt?

Oh yes, you will have to pay the hospital or CAs legal fees as well as the original debt plus interest.

Originally Posted by pigoi

Can the damage to credit be quantified and recovered? From whom?

Hospital hasn't suffered any damage to their credit over this. You don't need to worry about that here. And if you are actually stupid enough to mean damage to your credit, you haven't suffered any damage either. You didn't pay the bill and it is accurately reported.

Originally Posted by pigoi

Suppose no trial happens by 2011. Any way the debt is not removed from my credit reports?

The laws could change between now and then.

Originally Posted by pigoi

Can the issue come back later?

Yes.

Originally Posted by pigoi

I have the means to pay the bill but feel like that would be giving in to blackmail; and now my credit is damaged anyway, right?

Are you truly stupid or just pretending? I hope they sue you. You are the debtor I love referring to legal.

You took your kid to the doctor. You are responsible for the bill. It is your responsibility to make sure that it gets paid if you choose to use insurance. You neglected this bill. Whose responsibility is it :::: Yours.

DC

[pcgumshoe]

Color me stupid, but where did you contact the HMO?!

Second, a doctor who won't talk to you? You must have done something to offend them (like threatened to sue?!)

Next, nobody wants to talk to you? That sounds VERY strange.

I will admit, doctors and hospitals do NOT want to go back and correct their mistakes. I had a medical bill from 2001 and in 2005 I contacted the OC and told them that I had insurance and they should have billed that insurance. With due diligence (even though the first person I spoke to SWORE I wasn't going to get the bill paid by my insurance) I got it paid!

If you don't want them to contact you, tell them so. If you don't want to pay this, don't. If you want the responsible party to pay this, you must contact the HMO and validate coverage period. If you were covered during the time, did the hospital tell you they don't take your insurance?

Something smells fishy.

[pigoi]

I am surely guilty of procrastination. But I still claim I never owned the bill.
I do not feel guilty about not paying since recently I found my old insurance
card and it does state "emergency room - copay 0". Read more!

I did not threaten to sue anyone, only asked the hospital to correct
billing mistakes immediately, and the affiliated primary doctor to help.

I did not call the hospital billing center since the first letter from the
collection agency says "our client requested you only call us".

Today I waited three hours to get to talk to the HMO for the first time about
this bill. Here is what the HMO representative said:

1) The hospital did submit a claim to the HMO

2) The HMO wrote a $2048 check to Dr. ****** of the hospital!
Note that the collection agency only wants $584. Will they ask for more later?

3) The check was mailed back to the HMO in May 2004!

4) The HMO does not pay claims more than one year old
Note that I am not using this HMO since June 2004.

Now naturally I asked for a letter with these facts,
even though I am not sure the facts help me. So:

5) Their representative said she can only send me "form letters" and gave me
some useless advice (like billing my current insurance).
I'll post the form letter when I get it, but I don't believe it will have the
details above - the never-cashed check to be precise.

The conversation took a turn so unexpected that I forgot to ask about
my previous sentence, in the letter to the hospital, that
"the HMO-hospital contract prohibits the hospital billing me".
I used that sentence since it was true in April 2003 - the HMO arranged for
a hospital bill to be dismissed using "the contract prohibits ...".

[debtcollector`]

why ask for advice when you have all the answers? Good luck with that.

[Chien]

I gues it's an aside at this point but, if the CA "sent a list of medical procedures performed" in 2006 in response to a telephonic request for an "explanation of the bill", I think they overstepped the HIPAA Privacy Rule.

[ecmst12]

They sent the itemized bill to the patient's parent, that's legal.

You need to find out WHY your former insurance company did not pay this bill, if indeed they ever received it. It could be separate from the one they paid. And it could be correct that you owe it, though I don't think that's likely. More likely it was denied for late submission which is NOT your responsibility with a contracted hospital. But you need more information from the HMO. Send them a copy of the itemized bill.

[Chien]

I won’t argue with you; we’d be getting off point, and I think you’re right about the delayed submission. But the statement made by the OP is that they “sent a list of the medical procedures performed” to someone they assumed to be the parent.
A CA doesn’t need that information to perform their function as a Business Associate of the healthcare provider. It can be reduced to metadata or encoded (eg. procedure 004 by Dr. Jones – 1/1/07 -$100.00). Let the inquiree go directly to the original source.
And despite the fact that HIPAA permits informal disclosure, I doubt that you’ll find a healthcare provider extant that doesn’t request written authorization. The Business Associate doesn’t have more latitude than the provider.
The financial penalties are stiffer than FDCPA violations. For the CAs for which I do compliance consulting, I don’t want them to even receive a “list of the medical procedures performed”, much less send it to someone who calls of the phone and says “I’m Jimmy’s mother”.
If you don’t think that conservatism is a sufficient and prudent approach in this regard, I’ll tell you the true story of the nun, who wanted her medical billing, which reflected an HIV test procedure, sent to the archdiocese for payment.

[debtcollector`]

The question there is whether the CA sent the list or forwarded the request to the hospital who sent a copy of the billing.

Remember, we in the industry and consumers refer to things by different names.

DC