Please Help -- Don't know what else to do

[Armatur]

What is the name of your state? AZ

Hi Everyone --

Last year I posted a question regarding a medical billing issue and I didn't get any answers (I will copy the entire post below). Things have progressed to the point now where I don't know what to do and I've been contacted and harassed by a collections agency and I am hoping someone in this particular section may have some answers for me on further steps I can take?

In a nutshell, I had a prodecure at an AZ surgery center when I still was a CA resident. The insurance was complicated and under two different names depending on what state I was in. The center quoted a $250 co-pay and swore they pre-authorized the procedure with the correct company and that would be all I would be responsible for.

About two months after the procedure I got a bill in the mail for almost $1800! In addition to the $250 I had alread paid! When I tried to contact them they didn't answer faxes or phone calls and just sent me more bills. I hired a pre-paid legal lawyer because that's all I could afford and she wrote them a letter disputing the debt (this was after I had written them myself). Recently, I received another bill and a harrassing phone call from what I have come to find out is a collection agency. They have also reported this "debt" to Experian and now my credit record (which was perfect) is marked up. Meanwhile, I just received a letter from the collection agency lawyer who said I needed to dispute the debt within 30 days or they would know it was valid. Again, my pre-paid lawyer is writing them a letter and disputing it but to me, it just seems like we're going around and around and it's a HE SAID SHE SAID kind of thing. I just don't know what else to do. I can't pay it... And frankly, I don't want to. I still really do feel they screwed me. If they had pre-authorized it with the CORRECT company in the first place, they would have found out AHEAD of the procedure it wouldn't be covered and I could have had the choice not to go forward. They misrepresented that everything was covered and then turned around after the fact and said 'Oh sorry...if you had explained it all better we could have avoided this situation."

I'm just feeling hopeless about this. I think that after this next letter the pre-paid lawyer is sending, that's really all they can do.

What should I do now?? They say it's a valid debt but I say it's not. I'm just so stressed out and worried. I'm just hoping that someone here has some advice on what actions I can take or should avoid taking to protect msyelf further? I know it doesn't seem like a lot of money but to me, right now, it really is. If I had known the procedure would cost so much at that office I would have flat out said no and gone somewhere I would have been covered. The fact that they lied to me and told me it was all taken care of is just so upsetting! I was so sick and on drugs during that time and it's so hard not to be able to depend on people to tell the truth. And now I have collections on my back for something I just think is awful and unfair.

Anyway, thank you for any help you can offer. Here is the copy of my original post that explains everything in detail. Sorry this is all so long!

Help please - Dishonest Surgery center and what can I do?
What is the name of your state? AZ

Late last year I was visiting in AZ when I ruptured 3 disks in my back and had all the residual problems associated with that including surgery, medication, and finally a procedure called an injection at one of the local outpatient surgery centers.

It was very complicated because my insurance was from CA and in CA it was called Healthnet yet when I am in AZ (or just out of state) it was to be billed under a separate name called First Health Providers.

To make a very long story short, every time I had a procedure or went in for an appt, I stated very clearly that my insurance was NOT healtnet -- I was ADAMENT about it because one of the hospitals when it all first started had billed it wrong and I almost ended up getting a bill for $20,000! Anyway, I was very clear. I had to be.

So my doctor's office set up an appt with an outpatient surgery center who quoted me a $250 co-pay for an injection. The office was told about my insurance (I overheard them being told on the phone as well did my own mother) when we were sitting in the office. Also, the outpatient center called me and interviewed me thoroughly before the procedure and I made it very clear once again that they needed to be very sure about my insurance and having it billed correctly.

On the day of the procedure when I went in and filled out the paperwork, I showed the girl at the front desk my insurance card (she made a copy) and clearly stated once again "Are you sure everything is correct and you are NOT billing me under Healthnet?" I had a witness with me (my mom's best friend who had driven me). I was as clear as could be with every single person I came into contact with during this entire episode. Time and time again I was assured that the insurance was fine and I was covered except for the $250 co-pay.

So flash forward about two months after the procedure and imagine my surprise when I got a bill in the mail for almost $1800! In addition to the $250 I had alread paid! Obviously I was upset but I just figured it was a mistake and could be rectified like my hospital bill had been. Well, I faxed their office (and called) and no one responded to me. I waited another month or so and faxed and mailed their office with a letter clearly stating everything from my point of view and my disappointment in the fact that they had even failed to respond. About a week later I got a certified letter from the billing office that was condescending and basically said GEE, SORRY, IF YOU HAD EXPLAINED YOUR SITUATION TO US WE MAY HAVE BEEN ABLE TO AVOID THIS but seeing as you didn't, you are responsible for this bill.

I was livid. Not only were they just condescending *******s in the letter, the fact that no one called me, no one said boo until I had to write to them twice and beg for answers and then they were telling me they had no idea about my insurance situation just about sent me over the edge.

The fact is, they did know. And someone in that office is covering someone else and I am the one who's going to end up getting the short end of the stick.

I wrote them again and countered what they said by the facts and I offered a moment by moment account and flatly said that I would have had to set myself on fire to be any clearer when I had explained to EVERYONE in their office what my insurance situation was.

So a month has gone by and today one of my friends who ended up renting my house in CA called and said she had received a bill for me today from the outpatient surgery center for the $1800 plus $92 in interest.

A) Why in the world would they send the bill to CA when they know I'm here in AZ and that's the address that has been used with all other correspondence.

B) I am just completely baffled that someone in their office is not at least trying to be understanding about this situation and give me the common courtesy of calling and talking with me or responding to my last letter.

I am just at a loss here. Do I have any recourse whatsoever in this situation? I have been wiped out with medical bills this year and while $1800 may not be a lot to some people, it's a lot to me -- especially when my co-pay for that surgey was only $250 had I been somewhere that the insurance was good. I feel like I did everything in my power to go through the right channels and protect myself and I still got screwed.

I can't afford to pay them and honestly, on principal alone I have a problem paying them. On the other hand, I've worked hard to have good credit for years and I don't want one screw up that wasn't even my fault to mar my good name and history.

Please, if anyone knows what I should or can do in this situation, I would be most appreciative.

Thank you for your help in advance!
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What is the name of your state?

[ajkroy]

What did the insurance company say? What was their reasoning for not paying? What was on the Explanation of Benefits?

In my experience (nearly 13 years performing and teaching medical billing), this is usually nothing more than a clerical error. Of course, these errors are almost unilaterally in the insurance company's favor.

You said that the insurance operates under different names. If the provider didn't bill the correct insurance, then you are on the hook for the whole amount. You MIGHT be able to negotiate a smaller bill (down to what the insurance would have paid)...but that is iffy. It is the patient's responsibility to follow up to make certain that the correct insurance is billed in a timely fashion.

One final thing: in the future, never take a provider's "word" that something is covered. Read your contract and then call the insurance yourself to verify. It will save you a lot of headaches and possibly a ton of money. Just my two cents.

Good luck.

[Armatur]

Originally Posted by ajkroy

What did the insurance company say? What was their reasoning for not paying? What was on the Explanation of Benefits?

In my experience (nearly 13 years performing and teaching medical billing), this is usually nothing more than a clerical error. Of course, these errors are almost unilaterally in the insurance company's favor.

You said that the insurance operates under different names. If the provider didn't bill the correct insurance, then you are on the hook for the whole amount. You MIGHT be able to negotiate a smaller bill (down to what the insurance would have paid)...but that is iffy. It is the patient's responsibility to follow up to make certain that the correct insurance is billed in a timely fashion.

One final thing: in the future, never take a provider's "word" that something is covered. Read your contract and then call the insurance yourself to verify. It will save you a lot of headaches and possibly a ton of money. Just my two cents.

Good luck.

When they billed the insurance company (the right one), they said it wasn't covered because it was out of network. And that was true... It WAS out of network which would have been found out in the first place if they had tried to pre-authorize it with them as they said they did. They told me flat out they had pre-authorized it and everything was taken care of. Normally I would have done my due dilligence and checked everything out thoroughly but I was very sick and very drugged up and they were sending me directly from one office to another and there was no time for me to do anything but trust in what I was being told.

It really didn't have anything to do with being billed in a timely fashion... The procedure should have NEVER EVER taken place at that office. I just find it so hard to believe that they can flat out lie and tell me it was only going to be $250 and then turn around and say oh sorry... it's now $2000 or more because your insurance isn't going to pay seeing as we weren't covered by them like we told you we were.

Just really frustrating. I would have NEVER had it done there if it has just been presented correctly to me and I had the choice instead of being lied to And now here I am being chased by a collection agency for a bill I have no money to pay. Furthermore, the office never tried to even talk to me about it. I tried in vain to talk with them and possibly get the bill lowered and all they did was send me bills and not respond to calls or faxes. I just think the healths system is so messed up. It's frightening to say the least.

Thanks for your advice though. I wish it was more hopeful

[ajkroy]

Sorry I couldn't do more...but all may not be lost. Though it may be a little late, you can still try the negotiation route. There might be notes in your chart that someone attempted to preauthorize. In addition, insurance companies keep records of every call -- you should find out if a call to preauthorize was made on your behalf and the results, if any, of that call.

Arm yourself with as much information as you can and then make an appointment to speak to the billing manager of the provider. Show them your information and try to appeal to their better nature. You should be able to get them down to whatever they would have received from the insurance, or just ask to pay half. Even if you don't feel you should have to pay it, the provider DID perform a service to you and should be paid. Besides, it would save your credit.

One caveat: once negotiations are over, expect to pay the entire bill right then and there. Maybe take a small loan or put it on a credit card.

Good luck.